Clinical Anesthesiology Research Articles

The Impact of an Interactive Unconscious Bias Training on Perioperative Learners.

Providers' unconscious biases reinforce health disparities through negative direct patient care and interactions with colleagues. We created a workshop grounded in Critical Race Theory and the importance of different intersectionalities to improve medical trainees' self-assessment of their implicit biases in curated facilitated spaces. A total of 44 UCSF first-year clinical anesthesiology residents (CA-1) (95% response rate) and 23 surgery residents in their research year (77% response rate) participated in this workshop over 4 separate sessions in September 2020 and 2021. Quantitative data from a pre-/post-workshop survey was analyzed via a paired t test to evaluate our workshop's effectiveness. Feedback on efficacy was obtained by coding themes from our survey's open-ended questions. The workshop was evaluated positively by a total of 65 of 67 participants in the post-workshop survey. On a 5-point Likert scale, participants self-reported they agreed that their unconscious biases affect their clinical interactions from a pre-workshop mean of 3.3 (SD ± 1.32) to a post-workshop mean of 3.9 (SD ± 0.87, P = .008). Our findings suggest that this workshop was effective for perioperative residents and can be extrapolated to all residents by tailoring the workshop to their respective work environments.

Human dissection for anesthesiology resident training augments anatomical knowledge and clinical skills.

Anatomy is an essential component of clinical anesthesiology. The use of simulated patients and alternative materials, including embalmed human bodies, have become increasingly common during resident physician training due to the deemphasis on anatomical education during undergraduate medical training. In this report, the need for a more extensive review of relevant anatomy for the practice of anesthesiology was addressed by the design, evaluation, and dissemination of a human dissection course for procedural training of anesthesiology residents. The course utilized "freedom art" embalmed human bodies that allowed trainees to perform ultrasound-based regional and neuraxial techniques followed by detailed dissections of critical anatomy. One hundred and four residents participated in workshops and small group discussions and were evaluated using pre- and post-course assessments. A variety of clinical techniques were performed on the bodies, including regional blocks and neuraxial catheter placement. Insertion of peripheral/neuraxial catheters was successful, with dissections demonstrating the expected placement. Assessment scores improved following the course (pre-course mean 52.7%, standard deviation (σ) 13.1%; post-course mean 72.2%, σ 11.6%; t-test p < 0.0001) and feedback highlighted the usefulness and clinical relevance of course content. The ability to correlate ultrasound imaging with subsequent dissections of the "blocked" area and visualization of dye staining was extremely relevant for spatial understanding of the anatomy relevant for the clinical practice of these techniques. This manuscript demonstrates successful implementation of a comprehensive course for anesthesiology resident physicians to address gaps in undergraduate anatomical education and suggests that broader adoption of dissection courses may be beneficial for training anesthesiologists.

Implementation of an Un-Pairing Passport to Improve the Transition From Intern to Resident During a Critical Period of Anesthesiology Residency Training.

The transition from intern year to the first year of clinical anesthesiology residency (CA-1) is a challenging period for residents and their supervisors. Orientation methods and instructional material targeting this transition vary across U.S. residency programs. An un-pairing passport was implemented during the 2021-2022 transition to guide and provide expectations for interns, senior residents, and staff. The objective of this quality improvement project was to assess the effectiveness of the passport in improving the transition period and overall preparedness of the new CA-1s. We surveyed 3 groups (CA-1s, CA-2s/CA-3s, and staff anesthesiologists) 6 months after the completion of passport implementation to retrospectively assess the 2021-2022 CA-1 class's preparedness across 7 domains compared with those who transitioned before passport implementation. Mann-Whitney U statistics and median effect sizes were used to compare pre- and postintervention. Self-reflected preparedness scores of the CA-1s were higher across all domains compared with the senior resident group (r = 0.328-0.548). Overall level of comfort and preparedness for the start of the CA-1 year was higher in the postintervention group (r = 0.162- 0.514). Staff anesthesiologists' perceived preparedness of the residents was also higher across all domains for the postintervention group (r = 0.197-0.387). The un-pairing passport improved residents' and staff anesthesiologists' subjective assessments of the readiness of new CA-1 residents after a critical transition in their training. Similar tools can be more broadly applied to other anesthesiology residency and possibly fellowship programs as well as subspecialty rotations within those programs.

Bibliometric and visual analysis of intraoperative hypotension from 2004 to 2022.

Intraoperative hypotension (IOH) is a common complication occurring in surgical practice. This study aims to comprehensively review the collaboration and impact of countries, institutions, authors, journals, keywords, and critical papers on intraoperative hypotension from the perspective of bibliometric, and to evaluate the evolution of knowledge structure clustering and identify research hotspots and emerging topics. Articles and reviews related to IOH published from 2004 to 2022 were retrieved from the Web of Science Core Collection. Bibliometric analyses and visualization were conducted on Excel, CiteSpace, VOSviewer, and Bibliometrix (R-Tool of R-Studio). A total of 1,784 articles and reviews were included from 2004 to 2022. The number of articles on IOH gradually increased in the past few years, and peaked in 2021. These publications were chiefly from 1,938 institutions in 40 countries, led by America and China in publications. Sessler Daniel I published the most papers and enjoyed the highest number of citations. Analysis of the journals with the most outputs showed that most journals concentrated on perioperative medicine and clinical anesthesiology. Delirium, acute kidney injury and vasoconstrictor agents are the current and developing research hotspots. The keywords "Acute kidney injury", "postoperative complication", "machine learning", "risk factors" and "hemodynamic instability" may also become new trends and focuses of the near future research. This study uses bibliometrics and visualization methods to comprehensively review the research on intraoperative hypotension, which is helpful for scholars to better understand the dynamic evolution of IOH and provide directions for future research.

Application of online and offline blended teaching model combined with curriculum ideological and political education: Taking the course of clinical anesthesiology for example

Application of online and offline blended teaching model combined with curriculum ideological and political education: Taking the course of clinical anesthesiology for example

Expectations for the Clinical Anesthesiologist in Academia

Career Connection| December 2022 Expectations for the Clinical Anesthesiologist in Academia Kelly Wolfgang Kelly Wolfgang Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor December 2022, Vol. 86, 31. https://doi.org/10.1097/01.ASM.0000904268.90569.04 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Kelly Wolfgang; Expectations for the Clinical Anesthesiologist in Academia. ASA Monitor 2022; 86:31 doi: https://doi.org/10.1097/01.ASM.0000904268.90569.04 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: academia (organization) For clinical anesthesiologists in academia, there has been a longstanding expectation that, in addition to clinical work, a certain amount of time should also be devoted to research, journal publications, managing residents, or other academic pursuits. While those expectations still exist in some institutions, other are embracing the notion that, as clinical demands grow, academic institutions must compete for the best clinical anesthesiologists – often by forgoing academic expectations altogether. ASA Monitor spoke to experts on each side of the debate to see how institutions approach these standards and what the future holds. For many academic institutions, as has long been the standard, clinician anesthesiologists are often expected to devote time to academic pursuits. “While the primary focus is on patient care, there is an expectation that the clinician anesthesiologist will make scholarly contributions,” said Daniel J. Cole, MD, FASA. Dr. Cole is Professor of Clinical Anesthesiology at the University... You do not currently have access to this content.

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

Observation of the Application Effect of Multi-modal Teaching Method in Clinical Anesthesiology Teaching

Observation of the Application Effect of Multi-modal Teaching Method in Clinical Anesthesiology Teaching

Editorial introductions.

Editorial introductions.

Perception Precedes Reality: A Simulation and Procedural Bootcamp Improves Residents' Comfort With Transitioning to Clinical Anesthesiology Training.

BackgroundThe transition from internship to clinical anesthesiology (CA) training is often difficult given the differences in workflow, procedures, environment, and clinical situations. The primary aims of this study were to determine if a standardized introductory bootcamp could improve clinical knowledge and self-perceived comfort level of new anesthesiology residents in performing common operating room procedures and management of common intraoperative problems. The secondary aim of the study was to see if a standardized bootcamp could be replicated at other programs.MethodsThe introduction to anesthesiology resident bootcamp was developed at one institution in 2015 then expanded to a second program in 2019. The bootcamp was a one-day experience consisting of simulation and task trainers that all rising first-year CA residents (CA-1) participated in during their first month of anesthesiology training. All participating residents were given a survey immediately before and after the bootcamp. The average ratings of the questions were calculated and used as the primary measure. The Anesthesia Knowledge Test (AKT) was used as a surrogate measure of participant knowledge.ResultsFrom 2015 to 2020, a total of 105 residents completed the pre-survey and 109 completed the post-survey across the two sites. The improvement in average rating was significant (Pre: 2.04±0.46 versus Post: 3.09±0.52 p<0.0001). Individual item analysis also showed significant improvement on all of the eight items (p<0.0001). Analyses by site revealed the same results at both average score and item level. There was no significant cohort difference in either AKT-0 (Control: 57.84±26.86 versus Intervention 50.13±25.14, p=0.14) or AKT-1 (Control: 41.06±26.42 versus Intervention 41.70±26.60, p=0.90) percentile scores.ConclusionsIncorporation of an introduction to anesthesia bootcamp for new residents significantly improves participant comfort level and is reproducible across institutions. However, it does not improve resident performance on standardized tests.

How Do Institutional Conflicts of Interest Between Pharmaceutical Companies and the Healthcare Sector Become Corrupt? A Case Study of Scholarship Donations Between Department of Clinical Anesthesiology, Mie University, and Ono Pharmaceutical in Japan.

Institutional conflicts of interest (ICOIs) with pharmaceutical companies can bias internal operation of healthcare organizations. Naturally, a scholarship donation—which is a donation scheme unique to Japan, provided to healthcare organizations and their subunits to encourage educational and academic activities related to the development of new drugs—fall into the ICOI category. While anecdotal evidence exists that scholarship donations have been used as bribes by pharmaceutical companies, there has been little case study research that would illuminate the workings of this “gray area” mechanism. From this perspective, we offer an in-depth analysis of a recent scandal involving the Department of Clinical Anesthesiology, Mie University and Ono Pharmaceutical, where a scholarship donation was used by a pharmaceutical company to increase the prescription of one of its key drugs at a hospital department. Available evidence also suggests that a professor based within the department originally requested a scholarship donation from the company, which became an initial trigger of the scandal. We argue that by scrutinizing scholarship donations we can gain insight into problems specific to ICOIs between the pharmaceutical companies and the healthcare sector in Japan. In addition, scholarship donations can be understood as a form of “gifts” which have been found to underpin certain forms of pharmaceutical companies' promotional activities in Japan but also in other countries. We conclude by highlighting potential institutional remedies, which may alleviate ICOIs and corrupt behavior affecting the healthcare sector.

Exploration and Practice of the Collaborative Program in Postdoctoral Trainees of Clinical Anesthesiology

Exploration and Practice of the Collaborative Program in Postdoctoral Trainees of Clinical Anesthesiology

The Case for Modernizing the Third-Year Clinical Anesthesiology Residency Curriculum.

The Case for Modernizing the Third-Year Clinical Anesthesiology Residency Curriculum.

Application of CBL Teaching Method Combined with Situational Simulation Teaching in Clinical Teaching of Anesthesiology and Its Influence on Improving Theoretical Knowledge and Clinical Practice Ability of Anesthesiology Medical Students

Objective. To analyze the application of case based learning (CBL) teaching method combined with situational simulation teaching in clinical teaching of anesthesiology and its influence on improving theoretical knowledge and clinical practice ability of anesthesiology medical students. Methods. 42 anesthesiology medical students who came to our hospital for internship from March 2019 to March 2020 were selected as the research objects, and were randomly divided into the study group and the reference group, with 21 students in each group. The CBL teaching method combined with situational simulation teaching was adopted for the study group, while the traditional teaching mode was adopted for the reference group. After the teaching, both groups of students were assessed in theory and skill operation, and the scores were compared. Results. There was no significant difference in gender ratio, average age, only-child or not, home address and aspiration to choose this major between the two groups (P&gt;0.05). After training, the scores of theory test and skill operation in both groups were significantly higher than those before training (P&lt;0.001), and the scores in the study group were significantly higher than those in the reference group (P&lt;0.001). The scores of fill-in-the-blankquestions, noun explanations and essay questions of the study group were significantly higher than those of the reference group (P&lt;0.001). The study group was better than the reference group in deepening learning and memory,improving autonomous learning ability, stimulating learning interest, and cultivating clinical thinking (P&lt;0.05). The scores of professional practical ability, professionalattitude,management ability, interpersonal communication ability, professional development ability, and critical thinkingability in the study group were significantly higher than those in the reference group (P&lt;0.05). After training, the humanistic care abilityscores of both groups were significantly higher than those before training (P&lt;0.001), and the score in the study group was significantly higher than that in the reference group (P&lt;0.001).The total recognition of the study group was significantly higher than that of the reference group (P&lt;0.05). Conclusion. CBL teaching method combined with situational simulation teaching can significantly improve students’ mastery of theoretical knowledge and practical operation of clinical anesthesiology, and stimulate their humanistic care consciousness, which can lay the foundation for cultivating professional talents of anesthesiology in our hospital.

Residency Education Reform Program in Department of Anesthesiology and Critical Care: An Academic Reform Model.

BackgroundReform in medical education is a basic process in every academic department, especially in residency programs.ObjectivesThis study was designed to assess the indices of education and research as part of the Medical Education Reform program (MERP) in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU) for four years.MethodsMERP in DACC, SBMU was designed and implemented as a modern academic reform model; different outcome measures in education and research were assessed to demonstrate the effects of the reform plan in academic improvements.Resultsthere were significant improvements regarding education indices (i.e., teaching methods, passing comprehensive exams, mentorship, assessment methods, faculty development, professionalism in medical education, integration in education, and crisis management) and research indices (targeted research activities, innovation in research approaches, increasing the impact of research).ConclusionsBased on the experiences of DACC, SBMU regarding clinical anesthesiology residency, reform could be achieved using painstaking plans and continuous efforts with tangible documented outcomes. Often, the management period is not durable, and these reforms require meticulous care to sustain.

Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology

Objectives: Opioid-free anesthesia is used increasingly often in hospitals around the world. In this type of anesthesia, opioids are replaced by other analgesics, such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate. Many clinicians prepare these agents as dual, triple, or quadruple admixtures within a single syringe. However, data on the stability of the individual substances within these preparations over time and in different storage conditions is very limited. Here, we aim to investigate various admixture of dexmedetomidine, ketamine, lidocaine, and magnesium sulfate with respect to the stability of the individual agents over time at different storage conditions. Methods: An ultra-high performance liquid chromatography method coupled to mass spectrometric detection was developed and validated to determine the stability of lidocaine, ketamine, and dexmedetomidine. Quantification of magnesium was carried out in parallel by potentiometric titration. Results: Our results demonstrate the stability of dual, triple or quadruple mixtures of selected substances in 0.9% saline under different storage conditions. Under all conditions, analyzed admixtures remain stable for at least 8 weeks. The quadruple mixture of lidocaine, ketamine, dexmedetomidine, and magnesium sulfate was storable for as long as 148 days without a significant loss of analyte. Conclusion: A new chromatographic method was successfully developed to analyze the stability of various pharmacological agents commonly used by clinicians in opioid-free anesthesia. The data we obtained indicate that mixing these agents together in a single syringe is safe and reliable and suggest that hospital pharmacies may prepare these solutions in advance of planned surgeries.

Training the Trainer: Preparing Anesthesiology Residents to be Trainers in the Operating Room.

IntroductionThe transition into clinical anesthesiology is a challenging period that requires swift acquisition of clinical knowledge and procedural skills. Senior residents are in a prime position to help their junior colleagues into the operating room environment due to their ability to relate from personal experience. We created a workshop for enhancing peer apprenticeship during this transition.MethodsThe workshop consisted of PowerPoint didactics interspersed with small-group practice sessions. Surveys were administered pre-, post-, 1-week post-, and 1-month postworkshop. The primary outcome was pre-post improvement in the proportion of residents prepared to be a trainer. Secondary outcomes included pre- to 1-week postworkshop improvement, pre-postworkshop change in knowledge of learning theory concepts, and pre-postworkshop change in first-year clinical anesthesiology perceptions of trainers.ResultsOf residents, 12 of 43 (28%) eligible to be resident trainers attended the workshop. The proportion of residents who felt prepared increased from 75% preworkshop to 100% postworkshop and remained at 93% at 1 week. Knowledge of cognitive load and microskills improved from 0% preworkshop to 83% postworkshop but dropped to 0% at 1 month. Comfort using microskills improved from 0% preworkshop to 83% postworkshop.DiscussionEarly anesthesiology training demands rapid acquisition of novel cognitive and procedural skills. Senior anesthesiology residents are in a prime position to train junior residents, yet many are uncomfortable with this role. We developed a workshop to transition residents into a peer trainer role and significantly increased their confidence to be a trainer. Other programs may benefit from implementing similar training.

The Application of the Online and Offline Interactive Teaching Method in Clinical Anesthesiology Teaching

Objective. To explore whether better teaching effect can be achieved by applying the online and offline interactive teaching method to clinical anesthesiology teaching. Methods. Sixty-three students in grade three majoring in anesthesiology of Wenzhou Medical University were selected as research objects and randomly divided into 2 groups. The experimental group (32 students) adopted the online and offline interactive teaching method. The control group (31 students) adopted the traditional teaching method. The teaching effect was evaluated by the theoretical test results of the two groups and the survey of students in the experimental group. Results. The score of the theoretical test of students in the experimental group (79.31 ± 4.54) was higher than that of students in the control group (75.61 ± 4.88), and the difference achieved statistical significance p &lt; 0.05 . 81.3% of the students think that the interactive teaching method enhances the interest of learning. 90.6% (29/32) of the students in the experimental group hold positive attitude towards the fact that the overall learning effect can be improved by the online and offline interactive teaching method. Conclusions. The online and offline interactive teaching method can not only improve students’ theoretical test results but also help to improve students’ learning participation. Students have given a high score for the evaluation of the online and offline interactive teaching method; good teaching effect has been achieved.

Anesthetic Neurotoxicity in Children

The clinical pediatric anesthesiology community has been greatly affected by a growing body of research suggesting that sedative drugs and anesthetic agents may have long lasting detrimental neurocognitive effects in children. Various animal models have indicated apoptotic brain cell death and neurocognitive impairment following anesthetic exposure in early life. Although these studies cannot be directly extrapolated to anesthesia in children, parents and governmental regulatory agencies have been paying attention nonetheless. Adding to the evidence are a number of human epidemiologic studies that have documented neurologic deficits and cognitive decline following early anesthetic exposure. 1-4 Clinical studies in children exposed to general anesthesia have assessed outcome measures including academic performance or school readiness, validated neuropsychologic testing, and educational interventions for neurodevelopmental or behavioral problems.

Attitudes of the Third-Year Clinical Anesthesiology Residents Toward an Independent Clinical Practice Rotation in COVID-19 Pandemic in Iran.

BackgroundCOVID-19 was a worldwide pandemic with international health emergencies and great challenges; health care personnel shortage and physician burnout is a potential major challenge that should be planned and managed; especially in those countries with a high COVID-19 occurrence.ObjectivesThis study was designed to assess the attitudes of 3rd-year anesthesiology residents toward an independent one month-length clinical care course for patients with COVID-19.MethodsA closed self-administered questionnaire was developed to assess the attitudes of 3rd-year clinical anesthesiology residents. A self-administered closed questionnaire was developed. Cronbach’s alpha was calculated to measure the reliability of the questionnaire; added with a factor analysis process.ResultsAll 19 clinical anesthesiology residents took part in the study, with a 100% response rate. Cronbach’s alpha for the reliability of the questionnaire was 0.678. The eigenvalue for 8 factors was equal to 1; however, further assessment led us to 7 factors.ConclusionsThis one-month period could improve the competencies of the 3rd year clinical anesthesiology residents based on their viewpoints. Since the COVID-19 pandemic is ongoing health and social problem worldwide, 3rd-year anesthesiology residents could help the health system to recover health care delivery faults regarding manpower; a promising point for crisis preparedness in the COVID-19 pandemic. Besides, there were many constructive results for the clinical anesthesiology residents regarding their training and clinical service delivery.