Training Anesthesiology Residents Research Articles

Training Anesthesiology Residents to Care for the Traumatically Injured in the United States.

Training and education for trauma anesthesiology have been predicated on 2 primary pathways: learning through peripheral "complex, massive transfusion cases"-an assumption that is flawed due to the unique demands, skills, and knowledge of trauma anesthesiology-or learning through experiential education, which is also incomplete due to its unpredictable and variable exposure. Residents may receive training from senior physicians who may not maintain a trauma-focused continuing medical education. Further compounding the issue is the lack of fellowship-trained clinicians and standardized curricula. The American Board of Anesthesiology (ABA) provides a section for trauma education in its Initial Certification in Anesthesiology Content Outline. However, many trauma-related topics also fall under other subspecialties, and the outline excludes "nontechnical" skills. This article focuses on the training of anesthesiology residents and proposes a tier-based approach to teaching the ABA outline by including lectures, simulation, problem-based learning discussions, and case-based discussions that are proctored in conducive environments by knowledgeable facilitators.

Staying proper with your personal protective equipment: How to don and doff

IntroductionThe global COVID-19 pandemic highlighted the importance of protecting frontline healthcare workers from novel respiratory infections while also exposing the limited instruction that medical students receive on proper donning of personal protective equipment (PPE) and more importantly the safe doffing of contaminated PPE to minimize their risk of nosocomial infection. The best methods of providing this kind of instruction have not yet been determined. MethodsAnesthesiology interns and CA-1 residents were trained on proper PPE donning and doffing for AGPs using a methodology based on Miller's pyramid and following a “knows-knows how-shows-does” progression. Participants donned PPE without instruction and were sprayed with Glo Germ® to identify areas of contamination, after which they received both video and in-person instruction on best practices for donning and doffing PPE for AGPs. Following instruction, they again donned PPE and were sprayed with Glo Germ® to identify areas of contamination. Results54 participants completed the study. Before training, overall donning compliance was 60% and overall doffing compliance was 48%. Overall, 70% were contaminated after PPE doffing, with 46% having multiple sites of contamination. After training, donning compliance increased by nearly 30% (P < 0.001), doffing compliance increased by over 20% (P < 0.001), and overall contamination decreased by nearly 30% (P = 0.029), with multiple-site contamination decreasing to only 6% (P = 0.013). DiscussionWhile best methods for providing instruction regarding topics such as PPE donning and doffing have not yet been determined, we have demonstrated that the underlying knowledge base from medical school regarding proper donning and doffing for respiratory isolation is insufficient for preventing self-contamination, and that Miller's pyramid-based training using both video and in-person instruction combined with task execution by learners can improve compliance with PPE donning and doffing protocols and more importantly decrease skin contamination among a group of early training anesthesiology residents.

Novel 4W (When-Where-What-What) Approach of Training Point-of-Care Ultrasound (POCUS) Application in Resuscitation With High-Fidelity Simulator.

AimPoint-of-care ultrasound (POCUS) is a valuable tool in anesthesiology used for evaluating and managing cardiopulmonary pathology. Implications of this modality are extensive. Seamless integration into advanced cardiac life support (ACLS) has potential to improve resuscitation outcomes, and there is growing impetus for its implementation during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, it remains underutilized largely due to limited training. We use high-fidelity simulation and a novel 4W approach (when to apply POCUS, where to place the ultrasound probe, what images mean, what to do next) to incorporate this technique into resuscitation training. This study aims to evaluate the efficacy of a novel 4W POCUS approach for training anesthesiology residents in the setting of resuscitation.MethodsOur approach teaches learners when and where to implement POCUS, how to interpret their findings, and how to apply these findings in a clinical setting. Learners apply this method in high-fidelity simulation to diagnose and treat cardiopulmonary pathologies. Assessments were administered before and after training to evaluate efficacy.ResultsPost-test improvements were appreciated across all residency classes (n = 23), with achieved significance of P < 0.001 in the first-year clinical anesthesia class (CA-1) and P = 0.02 in the second-year clinical anesthesia class (CA-2). Performance was further subdivided into five categories: resuscitation integration, lung ultrasound, transthoracic echo, disease recognition, and treatment. Post-test scores also improved in each category, with lung ultrasound being the most significant improvement (P = 0.04).ConclusionsOur initial data demonstrate the effectiveness of this approach to POCUS training. Performance is improved and learners are more likely to use POCUS in the future. The application of this method to larger sample sizes is an appropriate next step to demonstrate its utility.

The Multiple Casualty Scenario: Role of the Anesthesiologist.

Purpose of ReviewMass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.Recent FindingsAnesthesiologists should be involved in all aspects of emergency preparedness—mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal with managing patients during natural and man-made (unintentional or intentional) disasters, one that takes into account a risk hazard analysis and institutional goals. Unfortunately, most practicing anesthesiologists have not had training and ongoing education for such events, and few academic centers train anesthesiology residents and staff to prepare for mass casualty scenarios.SummaryThe everyday clinical practice of anesthesiologists involves the utilization of some of the skills (vascular access, tracheal intubation) commonly required to successfully manage mass casualty scenarios. Anesthesiologists’ knowledge of anti-cholinesterases makes them subject matter experts on nerve agent poisoning, and their experience managing trauma patients will serve them well, depending on the nature of the mass casualty event. Practicing anesthesiologists however need to continually educate themselves on their role during mass casualty events. and current anesthesiology residency programs should develop a curriculum and incorporate simulation training to better prepare future generations of anesthesiologists.

Developing Modules to Train Anesthesiology Residents &amp; Medical Students in a Lung Isolation Technique

One-lung ventilation (OLV) can be accomplished by using ether a double-lumen endotracheal tube (DLT) or a bronchial blocker. Patient factors, surgical requirements and the anesthesiologist's expertise influence technique choice. Bronchial blockers are in general less traumatic, safer to place, and suitable in a wider variety of scenarios than DLTs, but require greater technical skill. We designed a study to determine whether trainees can achieve OLV using a bronchial blocker on completion of a 4-week multimodal training module. Anesthesia residents and medical students took part in didactic (lecture and video) and clinical simulation training. During simulation training, participants practiced placing a bronchial blocker under supervision until they performed the technique satisfactorily. Trainees could then practice independently as often as they wished. A skills check was performed during the supervised and after the independent practice; feedback was provided. For more advanced learners, practical clinical training was continued in the operating room. Assessments data (test scores and skills checks) were analyzed using the t-test. Difference between pre-test and post-test scores (didactics) was statistically significant (p=0.02) as was the number of skills checks items satisfactorily demonstrated by the 14 participants on the first supervised attempt and the last independent practice (simulation; p<0.01). All eight who performed one-lung isolation in the operating room were technically proficient in achieving adequate OLV to the satisfaction of the supervising attending anesthesiologist. This multimodal standardized teaching module which incorporates didactics, simulation training, and, for more advanced trainees, practical clinical experience, improves trainees' knowledge and skills in bronchial blocker placement and OLV.

Target-Controlled Infusion of Propofol in Training Anesthesiology Residents in Colonoscopy Sedation: A Prospective Randomized Crossover Trial.

BackgroundPropofol is widely used in sedation for colonoscopy, but its adverse effects on cardiovascular and respiratory systems are still concerning. The present study investigated whether target controlled infusion (TCI) of propofol could provide a better sedation quality than manually controlled infusion (MCI) in training inexperienced anesthesiology residents.Material/MethodsEighteen training residents were allocated into 2 groups receiving TCI and MCI training in their first month in the endoscopy center, while receiving MCI and TCI training instead in their second month. The last 2 patients at the end of each month were included to analyze the sedation quality of TCI and MCI techniques by comparing satisfaction of endoscopist and patients based on the visual analogue scale (VAS). Heart rate (HR), mean blood pressure (MAP), SpO2, and recovery time were also compared as the secondary outcomes.ResultsThe demographic data were similarly distributed among the TCI and MCI patients. Endoscopist’s satisfaction score in the TCI group was significantly higher than in the MCI group, 81.3±7.2 versus 74.2±9.5 (P=0.003), but the patients’ satisfaction score was similar between the 2 groups. More stable hemodynamic status was obtained in the TCI group, manifested as higher lowest MAP and lower highest MAP than in the MCI group. Lowest SpO2 in the TCI group was significantly higher than in the MCI group. Patients in the TCI group recovered earlier than in the MCI group.ConclusionsTCI is a more effective and safer technique for anesthesiology residents in sedation for colonoscopy.

Simulation for transthoracic echocardiography of aortic valve.

Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve.

Adapting Simulation Curricula to the Future Needs of Anesthesiology.

We have discussed some examples of the types of program development strategies that are in common use and have presented examples of the type of performance gaps that can occur when a coordinated curriculum development process is not applied (or is applied in an uncoordinated fashion). We have outlined one method to develop a simulation-based curriculum focusing more on ways to identify how to "simulate what is needed" rather than using the "simulate what we know" style. We believe that curricula must be designed to continually evolve rather being conceived as a single finished program. We have attempted to illustrate what a designed simulation curriculum for training anesthesiology residents and faculty in the PSH might look like, and we have provided a sample scenario to illustrate how this process could be presented (Supplemental Digital Content 2, http://links.lww.com/AIA/A23, Supplemental Digital Content 3, http://links.lww.com/AIA/A24). Our hope is that this model may be applied to create simulation education curricula in a wide variety of areas. We suggest that it be a part of any attempt to create a standardized, longitudinal simulation-based assessment for residents or practitioners. A cohesive, strategic approach to simulation curriculum design and implementation will be required as we seek to create the same type of effective safety training in medicine that has been present in other high-risk professions.

Training Anesthesiology Residents in Providing Anesthesia for Awake Craniotomy

Bilotta, Fredrico; Titi, Luca; Lanni, Fabriana; Stazi, Elisabetta; Rosa, Giovanni Author Information

Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load

Study ObjectiveTo measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a “good-excellent” level of competence. DesignProspective study. SettingOperating room of a university hospital. Subjects7 volunteer residents in anesthesiology. MeasurementsResidents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual’s ability was based on the resident’s self-assessment score and the attending anesthesiologist’s judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). Main ResultsEach task had a specific learning rate; the number of procedures necessary to achieve “good-excellent” ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. ConclusionsAwake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides “good-excellent” ability.

Anesthesiology Residents-as-Teachers Program: A Pilot Study

The role of residents as teachers has grown over time. Programs have been established within various specialties to formally develop these skills. Anesthesiology residents are frequently asked to provide supervision for novice learners and have numerous opportunities for teaching skills and clinical decision making. Yet, there are no educational programs described in the literature to train anesthesiology residents to teach novice learners. To explore whether a resident-as-teacher program would increase anesthesiology residents' self-reported teaching skills. An 8-session interactive Anesthesiology Residents-as-Teachers (ART) Program was developed to emphasize 6 key teaching skills. During a 2-year period, 14 anesthesiology residents attended the ART program. The primary outcome measure was resident self-assessment of their teaching skills across 14 teaching domains, before and 6months after the ART program. Residents also evaluated the workshops for quality with a 9-item, postworkshop survey. Paired t testing was used for analysis. Resident self-assessment led to a mean increase in teaching skills of 1.04 in a 5-point Likert scale (P < .001). Residents reported the greatest improvement in writing/using teaching objectives (+1.29, P < .001), teaching at the bedside (+1.57, P = .002), and leading case discussions (+1.64, P = .001). Residents rated the workshops 4.2 out of 5 (3.9-4.7). Residents rated their teaching skills as significantly improved in 13 of 14 teaching domains after participation in the ART program. The educational program required few resources and was rated highly by residents.

Subspecialty Training in Pediatric Anesthesiology

Subspecialty Training in Pediatric Anesthesiology

Effectiveness of a simulator in training anesthesiology residents.

The educational potential of a computer-controlled patient simulator was tested by the University of Southern California School of Medicine. The results of the experiment suggest unequivocally that there is a twofold advantage to the use of such a simulator in training anesthesiology residents in the skill of endotracheal intubation: (a) residents achieve proficiency levels in a smaller number of elapsed days of training, thus effecting a saving of time in the training of personnel, and (b) residents achieve a proficiency level in a smaller number of trials in the operating room, thus posing significantly less threat to patient safety. The small number of subjects in the study and the large within-group variability were responsible for a lack of statistical significance in 4 of 6 of the analyses performed; however, all differences were substantial and in the hypothesized direction. Thus, despite the narrowly circumscribed tasks to be learned by the experimental subjects, the findings suggest that the use of simulation devices should be considered in planning for future education and training not only in medicine but in other health care professions as well.