Anesthesia Education Research Articles

Effect of pre-operative communication using anaesthesia information sheet on pre-operative anxiety of patients undergoing elective surgery-A randomised controlled study.

ABSTRACTBackground and Aims:Pre-operative anxiety can affect psychological and physiological parameters during the intra-operative period. Pharmacological measures used to reduce pre-operative anxiety have their associated adverse effects. Pre-operative anaesthesia education is one of the non-pharmacological tools to reduce anxiety, but very limited literature is available in the Indian scenario. Hence, this study was designed to evaluate the effect of pre-operative counselling of patients using anaesthesia information sheet on pre-operative anxiety of patients who underwent elective surgery as the primary outcome. Secondary objectives were to assess the pre-operative anxiety for surgery, correlation of demographic data with pre-operative anxiety, and the common causes responsible for pre-operative anxiety.Methods:Total 110 patients were randomly allocated into two groups. Group-A was counselled using anaesthesia information sheet and in Group-B, conventional counselling was done during pre-anaesthesia check-up. Anxiety scores for anaesthesia and surgery were measured using visual analogue scale for anxiety (VAS-A). VAS-A score was compared pre- and post-intervention. Effect of intervention was assessed by comparing reduction in VAS-A score in both groups with paired t-test. Data were analysed using STATA (14.2) version.Results:The mean reduction in VAS-A for anaesthesia was more in Group-A compared to Group-B (16.6 ± 6.9 vs. 4.4 ± 5.8; P < 0.001). The mean reduction in VAS-A for surgery was more in Group- A compared to Group- B (14.6 ± 7.8 vs. 4.8 ± 7.3; P < 0.001).Conclusion:Pre-operative counselling using anaesthesia information sheet is helpful in reducing pre-operative anxiety more efficiently. Further trials are required to assess transferability in other settings.

Implementation of an electroencephalogram-guided propofol anesthesia education program in an academic pediatric anesthesia practice.

Propofol total intravenous anesthesia (TIVA) is increasingly popular in pediatric anesthesia, but education on its use is variable and over-dosage adverse events are not uncommon. Recent work suggests that electroencephalogram (EEG) parameters can guide propofol dosing in the pediatric population. This education quality improvement project aimed to implement a standardized EEG TIVA training program over 12 months in a large pediatric anesthesia division. The division consisted of 63 faculty, 11 clinical fellows, 32 residents, and 28 nurse anesthetists at the Children's Hospital of Philadelphia. The program was assessed for effectiveness (a significant improvement in EEG knowledge scores), scalability (training 50% of fellows and staff), and sustainability (recurring EEG lectures for 80% of rotating residents and 100% of new fellows and staff). The key drivers included educational content development (lectures, articles, and hand-outs), training a cohort of EEG TIVA trainers, intraoperative teaching (teaching points and dosing tables), decision support tools (algorithms and anesthesia electronic record pop-ups), and knowledge tests (written exam and verbal quiz during cases). Over 12 months, 78.5% of the division (62/79) completed EEG training and test scores improved (mean score 38% before training vs 59% after training, p < .001). Didactic lectures were given to 100% of the fellows, 100% (11/11) of new staff, and 80% (4/5 blocks) of rotating residents. This quality improvement education project successfully trained pediatric anesthesia faculty, staff, residents, and fellows in EEG-guided TIVA. The training program was effective, scalable, and sustainable over time for newly hired faculty staff and rotating fellows and residents.

Anesthesia students’ perception of the educational environment and academic achievement at Debre Tabor University and University of Gondar, Ethiopia: a comparative cross-sectional study

BackgroundExcellence in Anesthesia education has been advocated to meet the current and future needs of the society. Educational environment plays significant role in determining students’ learning and academic achievement. This study assessed the perception of Anesthesia students on their educational environment and it association with their academic achievement at Debre Tabor University and University of Gondar.MethodsA comparative cross-sectional study design was employed on 3rd and 4th year students. Dundee Ready Educational Environment Measure (DREEM) was used to assess students’ perception on their educational environment. Perceived performance, Cumulative Grade Point Average (CGPA) and 100 MCQ items were used to assess the academic achievement of the students. An independent t-test was used to assess the differences in the perception of educational environment and academic achievements. Bivariate and multivariable linear regressions were fitted to assess the relationship between perception on educational environment and academic achievement. A P-value of less than 0.05 was used to declare the statistical significance.ResultA total of 123 students (91 from University of Gondar and 32 from Debre Tabor University) were participated on this study. The study showed no statistically significant differences between the groups on the perception of students on the educational environment on DREEM total and subscale scores, and academic achievements. However, there were statistically significant differences in some items of the educational environment measures. On multivariable linear regression; entrance exam result, students’ perception of teachers, students’ academic self –perception and students’ social self-perception showed positive correlation with students’ academic achievement (ß = 0.003 & P = 0.04, ß = 0.009 & P = 0.9, ß = 0.06 & P = 0.42, ß = 0.06 & P = 0.39, ß = 0.14 & P = 0.015 and ß = 0.13 & P = 0.023) respectively.ConclusionThe perception of students on the educational environment was found to be more positive and there was no statistically significant differences in total and domains of DREEM scores and academic achievement of students between the two institutions. Entrance exam result and more positive perception of the educational environment were positively associated with academic achievement of students.

Perception of Learning Environment Among Anaesthesiology Residents During the Pandemic in a Tertiary Hospital in India: Comparative Cross-Sectional Study.

The coronavirus disease pandemic has affected the postgraduate educational system infusing online teaching resulting in a blended teaching-learning experience especially in the field of anaesthesiology. Hence, we conducted this study to evaluate the effect of the introduc- tion of blended learning methods on students' perception of the learning environment among different years of anaesthesia residency training. We invited 44 residents belonging to 3 years (Y1, Y2, and Y3) of anaesthesia residency to complete the Dundee Ready Education Environment Measure questionnaire. This study was done during the coronavirus disease pandemic after 6 months of incorporation of blended learning methods into the teaching program. The first-year cohort was not exposed to traditional anaesthesia teaching. The student's perception of learning was assessed after 6 months of change in the teaching method. The total Dundee Ready Education Environment Measure scores and the individual domains were compared among the 3 years. There was a significant difference in the corrected Dundee Ready Education Environment Measure score between Y1 (154.2 ± 20.73 [145.11-163.29]) and Y2 (138.27 ± 22.12 [125.2-151.34]) with P = .027. There was no significant difference in the individual domains. Higher score in the first-year residents suggests that it is appropriate to introduce blended learning from the beginning of the course rather than slowly merging with the existing traditional face-to-face teaching-learning methods.

Factors influencing anesthesiologistsperceived usefulness of ACRM (Anaesthesia Crisis Resources Management) key points after a combined ACLS (AHA)-ACRM similation training

Background: The factors that may contribute to learners’ perception about the usefulness of Anaesthesia Crisis Resource Management (ACRM) key points are little known. Objectives: We investigated the link between demographic factors and the effect of an ACRM simulation training on anaesthesiologists’ perceived value of ACRM key points. Design: A prospective pre- and post-test survey from December 2017 to December 2019 of 111 anaesthesiologists involved into a combined ACRM-ACLS course in a simulation centre. Methods: Before and after the course participants were asked to indicate which were, in their opinion, the 5 ACRM key points most relevant for managing an anaesthetic emergency. No taxonomy tool of the 15 ACRM key points was used for teaching purposes. Main outcome measures: Pre-/post-course differences in participants’ subjective choices were connected by logistic regression analysis with demographic factors which included age, gender, years of work as anaesthesiologist, the amount of updating exposure, and familiarity with ACRM. Results: In median participants (47 M/64 F) had an age of 42 years (IQR 34-55 years), and 10 years working experience as anaesthesiologists (IQR 4-20 years). Around 20% of them had never heard of ACRM prior to this course. Communication was selected by up to 75% of participants without pre-/post-course differences. Although the other 4 ACRM points remained heterogeneously selected even after the course, we observed post-course vs pre-course increase in the selection rate of the ACRM points that address leadership, correct distribution of workload and utilization of all available resources. Among participants’ characteristics, the lack of familiarity with ACRM was the only significant predictor of the number of pre- to post-course changes in ACRM key points selection (OR=3.03, CI 95% 1.04 -9.09; p=0.0418). Conclusions: The familiarity with ACRM should be considered when planning ACRM training, especially in cases where the ACRM training is not yet part of a formal education in anaesthesia.

After nectarine: how should we provide anesthesia for neonates?

Neonates have a high risk of perioperative morbidity and mortality. The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) investigated the anesthesia practice, complications and perioperative morbidity and mortality in neonates and infants <60 weeks post menstrual age requiring anesthesia across 165 European hospitals. The goal of this review is to highlight recent publications in the context of the NECTARINE findings and subsequent changes in clinical practice. A perioperative triad of hypoxia, anemia, and hypotension is associated with an increased overall mortality at 30 days. Hypoxia is frequent at induction and during maintenance of anesthesia and is commonly addressed once oxygen saturation fall below 85%.Blood transfusion practices vary widely variable among anesthesiologists and blood pressure is only a poor surrogate of tissue perfusion. Newer technologies, whereas acknowledging important limitations, may represent the currently best tools available to monitor tissue perfusion. Harmonization of pediatric anesthesia education and training, development of evidence-based practice guidelines, and provision of centralized care appear to be paramount as well as pediatric center referrals and international data collection networks. The NECTARINE provided new insights into European neonatal anesthesia practice and subsequent morbidity and mortality.Maintenance of physiological homeostasis, optimization of oxygen delivery by avoiding the triad of hypotension, hypoxia, and anemia are the main factors to reduce morbidity and mortality. Underlying and preexisting conditions such as prematurity, congenital abnormalities carry high risk of morbidity and mortality and require specialist care in pediatric referral centers.

Anaesthetic National Teaching Programme for Students (ANTPS).

The COVID-19 pandemic has significantly undermined undergraduate anaesthetic teaching in spite of the vital role of the specialty against the pandemic. Anaesthetic National Teaching Programme for Students (ANTPS) was designed to meet the evolving needs of undergraduates and tomorrow's doctor by standardising anaesthetic training, preparing for final exams and equipping competencies vital for doctors of all grades and specialties. Our Royal College of Surgeons England-accredited University-College-Hospital-affiliated programme consisted of six-biweekly sessions were delivered online by anaesthetic trainees. Prerandomised and postrandomised session-specific multiple-choice questions (MCQs) assessed students' improvement in knowledge. Anonymous feedback forms were provided to students after each session and 2 months following the programme. 3743 student feedback forms (92.2% of attendees) across 35 medical-schools were recorded. There was a mean improvement in test score (0.94±1.27, p<0.001). 313 students completed all six sessions. Based on 5-point Likert scale, students who completed the programme showed an improvement in their confidence in knowledge and skills to face common foundation challenges (1.59±1.12, p<0.001) and thus felt better prepared for life as junior doctors (1.60±1.14, p<0.001). With an increase in confidence in students to pass their MCQs, Observed Structured Clinical Examinations and case-based discussion assessments, 3525 students stated they would recommend ANTPS to other students. Unprecedented COVID-19 factors impacting training, positive student feedback and extensive recruitment, demonstrate that our programme is an indispensable learning resource which standardises anaesthetic undergraduate education nationally, prepares undergraduates for their anaesthetic and perioperative exams and lays strong foundations for implementation of clinical skills required by all doctors, to optimise training and patient care.

A Study on the Role of Intelligent Medical Simulation Systems in Teaching First Aid Competence in Anesthesiology.

Anesthesiology is a subject with strong practicality and application. Undergraduate anesthesiology teaching needs to strike a balance between theoretical knowledge, clinical skill training, and clinical thinking development. Clinical probation and practice are an important part of undergraduate anesthesia teaching. Traditional clinical teaching uses real patients for demonstration and training, but as patients become more self-protective and less cooperative, there are not enough patients for clinical skill training. Simulation is to teach medical scenes in real life under the control of standardized technical guidelines and parameters. Since then, with the rapid development of computer technology, simulation technology and simulation teaching have been greatly developed and are more and more used in clinical teaching, skill evaluation, and scientific research. This study explores the effective methods of clinical teaching in anesthesiology by comparing the effectiveness of traditional teaching methods and simulation teaching methods in undergraduate clinical teaching. It is difficult to combine theory and practice in first aid, which does not allow them to directly receive and deal with emergency medical treatment and resuscitation. In China's current medical environment and patients' high demand for medical services, it is imperative to vigorously carry out simulated medical education. In the eastern part of Inner Mongolia, according to the advantages of teaching hospitals, our hospital took the lead in carrying out the simulation education project, which is still in the exploratory stage and not systematic enough. This study will help us to better carry out simulation teaching and improve the clinical skills of medical students in the future. Methods. The student group and class took the advanced simulator training as the experimental group, applied the advanced integrated simulator and other systems of the Norwegian company, referred to the international guidelines for cardiopulmonary resuscitation and cardiovascular first aid in 2005, and practiced in the emergency department during the clinical internship and “emergency clinical simulation training” course. The course includes basic life support, advanced life support, and comprehensive training of CPR (cardiopulmonary resuscitation) and endotracheal intubation. Results. The passing rate of simulated first aid practice was 94.4%; 100% of the students think it is necessary to set up the course, 91% of the students think it is practical, 91% of the students think the course content is reasonable and perfect, and 77%–100% of the students think the course has improved their first aid operation ability, comprehensive application of knowledge, and clinical thinking ability. Conclusion. Carrying out the course of “clinical simulated first aid training” through the advanced simulator system can effectively improve the interns' clinical first aid operation ability, teamwork ability, and self-confidence, improve the students' clinical thinking and judgment ability, and improve the service level to patients.

Experiences using an instrument for non-technical skills in nurse anaesthesia education: a focus group study

BackgroundAlthough there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists’ Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice.MethodsThis study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach.ResultsSix categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants’ experiences with using the instrument:Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour.Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation.Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance.ConclusionIncreased awareness of non-technical skills when using Nurse Anaesthetists’ Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists’ Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student’s learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.

Simulation-based education and training in anaesthesia during residency in Europe: where are we now?: A survey conducted by the European Society of Anaesthesiology and Intensive Care Simulation Committee.

Simulation-based education and training in anaesthesia during residency in Europe: where are we now?: A survey conducted by the European Society of Anaesthesiology and Intensive Care Simulation Committee.

A Ten-Year Analysis of Recent National Institutes of Health Funding for Anesthesiology Research in United States Medical Schools

The characteristics of recent National Institutes of Health (NIH) grant funding to anesthesiology researchers in United States (US) medical schools have not been systematically quantified. NIH funding to cardiac anesthesiologists has also not been estimated. The author conducted an internet-based analysis of NIH awards to anesthesiology researchers from 2011-2020 to identify the types, duration of funding, and amount of grants, and the terminal degree(s), faculty rank, gender, board certification status, and type of appointment of the grant recipients including those with an interest in cardiac anesthesiology. Observational study. Internet analysis. NIH grants recipients. None. NIH grant recipients affiliated with anesthesiology departments were identified from the Blue Ridge Institute for Medical Research website. The number of grants, years of support, and total amount of funding were quantified for research project grants (R series), mentored career development awards (K series), and other grants (U and P series) using NIH Research Portfolio Online Reporting Tools. The terminal degree(s), faculty rank, gender, and type of appointment of grant recipients were identified using department web pages. American Board of Anesthesiology (ABA) certification, National Board of Echocardiography Advanced Perioperative Transesophageal Echocardiography (TEE) certification, and previous or current Foundation for Anesthesia Education and Research (FAER) awards to NIH grant recipients were obtained from each organization's website. A total of 532 researchers received 1250 grants with 3844 cumulative years of funding amounting to $1,676,482,440. R series grants accounted for three-quarters of all funding. PhDs were awarded more than one-half of NIH grants. MDs had lower median numbers of projects, R01 grants, and total R series grants than their colleagues with PhD or MD PhD degrees, but MDs received more K awards. One hundred ninety-eight MD and MD PhD NIH grant recipients were ABA diplomates. These physician-scientists received 26.0% and 53.1% of R and K series grants, respectively. Thirty physician-scientists also held TEE certification; these individuals with an interest in cardiac anesthesiology were awarded 4.8% of all NIH grants. Full Professors were awarded more than three-quarters of R grants and amassed more than $1.3 billion in funding, whereas assistant and associate professors received the majority of K series grants. Male investigators received greater median R grants but fewer median K awards than female researchers. One hundred-fifteen previous or current holders of FAER grants were identified; these individuals earned a total of 240 NIH awards totaling $357.7 million. PhDs, Professors, and male researchers receive the majority of R01 and other R series grants to anesthesiology departments at US medical schools. Physician-scientists, including those interested in cardiac anesthesiology, are awarded a minority of R series grants. FAER continues to provide an important stimulus for subsequent NIH funding of physician-scientists in anesthesiology.

Is the competency-based curriculum, evidence-based?

Is the competency-based curriculum, evidence-based?

Five Institutions Tell Us How They Use Simulation in Regional Anesthesia Education

Five Institutions Tell Us How They Use Simulation in Regional Anesthesia Education

Need to review anaesthesia curriculum and education!

Need to review anaesthesia curriculum and education!

Newer teaching-learning methods and assessment modules in anaesthesia education.

The National Medical Commission in its recent guidelines has stated that postgraduate training in anaesthesiology should have clear objectives and be competency based. This means that the existing teaching–learning (TL) methods need a major face-lift. E-learning and blended learning including learning management systems, virtual classrooms, app-based learning, flipped classroom, podcasts, webinars, web-based collaborative education, reflective feedback, problem-based discussions and mentorship are some newer TL methods that can be adopted. Simulation can help teach technical and non-technical skills such as leadership, teamwork and communication. In line with TL methods, newer assessment methods have to be applied to revolutionise postgraduate anaesthesia education. Formative assessment and assessment of clinical skills are important and to do this, workplace-based assessment methods such as mini-clinical evaluation exercise, direct observation of procedural skills, multisource feedback, logbook and E-portfolio can be applied. Objective structured clinical examination, simulation-based assessment and E-assessment are other useful evaluation methods.

Importance of non-technical skills in anaesthesia education.

Rising concern about patient safety has resulted in growing interest in non-technical skills (NTS) among anaesthesiologists. Growing evidence suggesting the use of good NTS training in patient safety in simulated as well as real-world environment made them important in medical education. Both technical skills (TS) and NTS are interdependent. Successful task performance depends on effective integration of both TS and NTS for any given situation. Development of tools for assessing the NTS of an anaesthesiologist in improving health care outcomes is challenging. Teaching, understanding and evaluating NTS among anaesthesiologists in improving health care outcomes is a domain which is supposed to be a rich seam for future studies.

The changing face of postgraduate anaesthesia teaching curriculum: Need of the hour!

The speciality of anaesthesiology is evolving rapidly. The recent pandemic witnessed anaesthesiologists as the front-liners catering not only as critical care physicians but also as trainers and even administrators. Today, anaesthesiologists are required to have not just sound clinical knowledge but also proficiency in skills and techniques and aptitude for leadership. The recently introduced competency-based postgraduate training programme for anaesthesiology in India with its specific learning objectives envisages the creation of competent specialists with a broad range of skills who are competent not only to handle effectively medical problems but also acquire the basic teaching skills, communication skills and leadership qualities. The curriculum marks a paradigm shift from university-based, passive, teacher-centric to student-centric, active teaching-learning methods including problem-based and self-directed learning. The mindset, lack of adequately trained faculty, infrastructure, learning resources and time constraints form the major impediment in the successful implementation of the new curriculum.

A systematic review and meta-analysis of the influence of case analysis teaching in clinical anesthesia education.

The success or failure of anesthesia determines the success or failure of surgery. Therefore, more attention should be paid to the training of students majoring in clinical anesthesia. Traditional teaching methods rely on teacher explanation, and thus students depend greatly on their teachers. In recent years, case analysis teaching has become increasingly popular as an educational mode and is widely praised by students. Many studies have shown that case analysis teaching can not only improve students' enthusiasm but also enable students to apply what they have learned into clinical practice. The English databases PubMed, Embase, and Ovid MEDLINE were searched from database establishment to April 2021, with the keywords "case analysis teaching", "clinical anesthesia teaching", and "effect analysis". Review Manager 5.3 was used for meta-analysis of experimental data. A total of 3 documents involving 143 students were analyzed to investigate the influence of case analysis teaching in clinical anesthesia education. The results showed that after case analysis teaching, students in the experiment group scored significantly higher than those in the control group, and the difference was statistically significant (MD =2.50, 95% CI: 1.84-3.16, Z=7.41, P<0.00001). Studies have found that case analysis teaching allows students to better master knowledge. This meta-analysis analyzed 3 previous studies to investigate the influence of case analysis teaching in clinical anesthesia education.

Ağız Cerrahisi Kliniğinde Öğrenciden-Öğrenciye Lokal Anestezi Uygulamasına İlişkin Komplikasyonlar ve Öğrenci Algısı: Tanımlayıcı Araştırma

Objective: Student-to-student practice is the one of the most common preclinical training method for local anesthesia education in dentistry. However, the complications in this modality are relatively less known. This study aimed to evaluate the rate and types of complications and the perception of student-to-student local anesthesia education during dental education. Material and Methods: This prospective, single-center study was conducted on fourth-year dental students. As part of their clinical education, students performed inferior alveolar block anesthesia on each other at the oral surgery department. Two days after the training, local and systemic complications linked to local anesthesia were assessed. Overall perception and satisfaction level of the students related to the practice and education modality were also evaluated. Results: The study included 44 participants [median age, 22 years; female, 26 (59%)]. The rate of any local complication was 72.7%. Pain and burning on the injection site (65.9%) and trismus (15.9%) were the most common complications. Hematoma, soft tissue injury, facial paralysis, subluxation, and syncope were also observed (2.3%). All participants recommended the practice for future applications, while 88.6% were willing to access advanced educational modalities such as simulation. Also, 97.7% agreed that the student-to-student local anesthesia education improved their empathy level toward patients. The overall satisfaction level was 87.5% (70%-90%). Conclusion: Local complications were common after student-to-student inferior alveolar block anesthesia. On the other hand, the students were overall satisfied by this unique educational practice.

Anaesthesia education of our times.

Anaesthesia education of our times.