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Background and Aims: Inhalation anesthetics is basic knowledge that must be mastered by an anesthesiologist. Lack of competencies can result in higher morbidity and mortality in anesthesiology practice. Various learning methods were developed to improve understanding and retention. With the advancement of technology, the utilization of screen-based simulation (SBS) using applications is common, such as the Gas Man® application, to help students understand physiology, pathophysiology, and kinetic inhalation anesthetic agents. The primary objective of this study was to compare the knowledge improvement of anesthesia residents between the simulation-based and discussion-based learning methods on the uptake and distribution of anesthetic inhalation. The secondary objective was to compare the satisfaction levels of participants in both learning methods. Material and Methods: This study is a randomized controlled trial involving anesthesiology and intensive care residents from the Faculty of Medicine, Universitas Indonesia (FKUI) 2022–2023. The participants were randomized into two groups (simulation and discussion groups). A senior attending anesthesiologist led the discussion. The participants answered a pretest, followed by a 1-hour lecture about inhalation gas. Lastly, participants answered a posttest and filled in the satisfaction survey. Statistical analyses used the Mann–Whitney test to compare the two groups. The Wilcoxon test was used to compare the knowledge improvement between the two groups. Results: Thirty-eight residents underwent simulation-based (n = 19) and discussion-based (n = 19) learning methods. The simulation group demonstrated a median (interquartile range) posttest score of 80 (76.67–83.33) compared with the discussion group with a score of 50 (40–66.67) (P value more...

Background: Many residents report a second victim response following near-miss events during their pediatric anesthesia rotation with consequences for their mental and physical wellbeing. This study investigated the impact of a Better Resident Wellness (BREW) initiative at our tertiary pediatric centre. Methods: We invited anesthesia residents to complete a survey at the start of their pediatric rotation. Questions included the Second Victim Experience and Support Tool (SVEST). During their rotation, residents attended weekly BREW rounds, a one-hour peer discussion facilitated by a psychologist. They provided feedback in a follow-up survey, including repeat SVEST. Results: 33/48 (69%) invited residents completed pre- and post-surveys Oct/2021-Feb/2023: all had attended one or more BREW rounds; 32/33 (97%) considered BREW helpful, safe, and would recommend to future residents; perceived benefits included improved morale (30/33, 91%) and clinical care (23/33, 70%). SVEST indicated a second victim response for 17/32 (53%) at the start and 7/32 (22%) at the end of their rotation (odds ratio 0.25, 95% CI 0.07 to 0.82, p = 0.019), with reduced professional self-efficacy concerns (median difference -0.25, 95%CI -0.50 to 0, p = 0.029). Conclusion: BREW offers anesthesia residents a desirable and beneficial support resource. Other residency programs should consider integrating facilitated peer discussion into their curriculum. more...

Previous studies have demonstrated that residents participating in patient safety event investigations become more engaged in future patient safety activities. Currently, there is a gap in resident participation in patient safety event analyses. The objective was to develop and implement a sustainable, faculty-led curriculum for resident participation in patient safety event investigations and to evaluate resident perceptions of the training at least one year following completion of the training. One hundred sixty-five residents from three specialties participated in a formal RCA2 training curriculum from 2013 to 2019. In November 2019, the same residents were asked to complete a survey which examined their perception of the training including the tools and techniques such as event mapping, cause-and-effect diagramming, and developing action plans for solving problems and unsafe conditions. The survey response rate was 36 % (60/165). Sixty-three percent (38/60) of the residents responding to the survey believed that RCA2 training should be provided to all residents. Former residents rated the RCA2 training tools and skills favorably, 3.6 median score (3.5–3.7, 95 % C.I.). Forty-eight percent of responding residents (29/60) believed that the previous RCA2 training improved the way they identify and solve problems. The curriculum and faculty development program provides an effective intervention to address the current, identified gaps in patient safety in graduate medical education. more...

We created a serious game to teach first year anesthesiology (CA-1) residents to perform general anesthesia for cesarean delivery. We aimed to investigate resident knowledge gains after playing the game and having received one of 2 modalities of debriefing. We report on the development and validation of scores from parallel test forms for criterion-referenced interpretations of resident knowledge. The test forms were intended for use as pre- and posttests for the experiment. Validation of instruments measuring the study's primary outcome was considered essential for adding rigor to the planned experiment, to be able to trust the study's results. Parallel, multiple-choice test forms development steps included: (1) assessment purpose and population specification; (2) content domain specification and writing/selection of items; (3) content validation by experts of paired items by topic and cognitive level; and (4) empirical validation of scores from the parallel test forms using Classical Test Theory (CTT) techniques. Field testing involved online administration of 52 shuffled items from both test forms to 24 CA-1's, 21 second-year anesthesiology (CA-2) residents, 2 fellows, 1 attending anesthesiologist, and 1 of unknown rank at 3 US institutions. Items from each form yielded near-normal score distributions, with similar medians, ranges, and standard deviations. Evaluations of CTT item difficulty (item p values) and discrimination (D) indices indicated that most items met assumptions of criterion-referenced test design, separating experienced from novice residents. Experienced residents performed better on overall domain scores than novices ( P more...

Background: Previous studies have suggested the use of ultrasonography for more success in spinal anesthesia. The purpose of this study was to compare the effect of ultrasonography and traditional method on the success rate of spinal anesthesia by an anesthesia resident.Methods: In this clinical trial study, patients who were candidate for leg or lower abdominal surgery under spinal anesthesia and referred to Firoozgar and Rasoul-e-Akram hospitals in 2019 were randomly assigned to techniques: 1) common surface marking techniques and 2) the use of ultrasonography to find the spinal canal. The dural puncture success rate at the first needle entry attempt, time required for determining the needle entry site, time required for needle entry until CSF exit, number of needle redirection without complete skin exit, and needle entry after complete needle withdrawal in each group were measured and recorded.Results: The success rate of dural puncture at the first attempt of entry and the time required to determine the needle entry site in the ultrasonography group (55.2%) was significantly higher than that in Landmark group (21.4%) (P more...

Objective To assess the capability of senior residents in clinical competency, and to compare the difference between examiner grading and examinee grading. Methods 44 third year residents attended the oral examination in 2018 and 2019. The oral exam lasted 20 minutes covering questions from preoperative evaluation, intraoperative management, and to postoperative management. Two examiners participated in the oral exam. Results The examiners gave the grading of 3.54±0.72 for majority of the time, and gave the grading of 3.34±0.94 for minority of the time. The residents showed the best ability in oral communication skills appropriate for level in residency, and showed the poorest ability in being able to adapt to changes in the clinical situation 3.28±0.77 and understanding advantages and disadvantages of alternative management strategies 3.29±0.73. The examinee gave the grading of 3.17±0.63 for majority of the time, and gave the grading of 3.09±1.12 for minority of the time. The residents evaluated themselves the highest score in communicates information logically and effectively 3.34±0.81, and evaluated themselves the lowest score in being able to adapt to changes in the clinical situation 3.07±0.70 and understanding advantages and disadvantages of alternative management strategies 2.84±0.75. Most of the residents (73%) reached the score equal or more than 3. Examinees intended to underrate themselves significantly(P＜0.05). Conclusions Most of the third year residents showed appropriate clinical competence acquired for this stage. Residents in anesthesia should practice more in understanding advantages and disadvantages of alternative management strategies and in being able to adapt to changes in the clinical situation. To improve the clinical competence, practice oral examinations should be instituted in the resident training programs in China. more...

BackgroundPostoperative delirium is a common and serious problem for older adults. To better align local practices with delirium prevention consensus guidelines, we implemented a 5-component intervention followed by a quality improvement (QI) project at our institution.MethodsThis hybrid implementation-effectiveness study took place at 2 adult hospitals within a tertiary care academic health care system. We implemented a 5-component intervention: preoperative delirium risk stratification, multidisciplinary education, written memory aids, delirium prevention postanesthesia care unit (PACU) orderset, and electronic health record enhancements between December 1, 2017 and June 30, 2018. This was followed by a department-wide QI project to increase uptake of the intervention from July 1, 2018 to June 30, 2019. We tracked process outcomes during the QI period, including frequency of preoperative delirium risk screening, percentage of "high-risk" screens, and frequency of appropriate PACU orderset use. We measured practice change after the interventions using interrupted time series analysis of perioperative medication prescribing practices during baseline (December 1, 2016 to November 30, 2017), intervention (December 1, 2017 to June 30, 2018), and QI (July 1, 2018 to June 30, 2019) periods. Participants were consecutive older patients (≥65 years of age) who underwent surgery during the above timeframes and received care in the PACU, compared to a concurrent control group more...

Spinal anesthesia, as a basic skill, needs to have a consideration in the design of the learning process in any training program. This study aimed to follow up on the learning curve of the junior resident during their training program to know the duration and the number of cases needed by the trainee to be skillful in spinal anesthesia. for six months, the trainee were monitored to check their ability and excellence to achieve optimum spinal anesthesia using a checklist, learning curve, and strict crystal clear endpoint to achieve a 90% success rate The learning curve indicated a rapid improvement of skills, 50 attempts (cases), done over about 100 days with approximately 13 hours of residency work per day is enough for a trainee to achieve a success rate of 90%, as set by the criteria in this study. By using learning curves, it is possible to generate the minimal numbers of each manual procedure required to achieve an adequate success rate [ABSTRACT FROM AUTHOR] more...

Central line placement, cricothyroidotomy, and lumbar epidural placement are common procedures for which there are simulators to help trainees learn the procedures. However, a model or a simulator for thoracic epidurals is not commonly used by anesthesia training programs to help teach the procedure. This brief technical report aims to share the design and fabrication process of a low-cost and do-it-yourself (DIY) 3D-printed thoracic spine model. Ten expert anesthesiology attendings and fifteen novice anesthesiology residents practiced with the model and were subsequently surveyed to assess their attitudes towards its fidelity and usefulness as a teaching tool. Responses were recorded with a Likert scale and found to be positive for both groups. Design files and an assembly manual were developed and made public through an open-source website. more...

Background and Aims: Inhalation anesthetics is basic knowledge that must be mastered by an anesthesiologist. Lack of competencies can result in higher morbidity and mortality in anesthesiology practice. Various learning methods were developed to improve understanding and retention. With the advancement of technology, the utilization of screen-based simulation (SBS) using applications is common, such as the Gas Man® application, to help students understand physiology, pathophysiology, and kinetic inhalation anesthetic agents. The primary objective of this study was to compare the knowledge improvement of anesthesia residents between the simulation-based and discussion-based learning methods on the uptake and distribution of anesthetic inhalation. The secondary objective was to compare the satisfaction levels of participants in both learning methods. Material and Methods: This study is a randomized controlled trial involving anesthesiology and intensive care residents from the Faculty of Medicine, Universitas Indonesia (FKUI) 2022–2023. The participants were randomized into two groups (simulation and discussion groups). A senior attending anesthesiologist led the discussion. The participants answered a pretest, followed by a 1-hour lecture about inhalation gas. Lastly, participants answered a posttest and filled in the satisfaction survey. Statistical analyses used the Mann–Whitney test to compare the two groups. The Wilcoxon test was used to compare the knowledge improvement between the two groups. Results: Thirty-eight residents underwent simulation-based (n = 19) and discussion-based (n = 19) learning methods. The simulation group demonstrated a median (interquartile range) posttest score of 80 (76.67–83.33) compared with the discussion group with a score of 50 (40–66.67) (P value <0.05). More than half of the participants in both groups answered "satisfied." Conclusion: The simulation-based learning method using the Gas Man® application performed better than the discussion-based learning method on increasing knowledge of the uptake and distribution of inhalation anesthetics in anesthesia residents. [ABSTRACT FROM AUTHOR] more...

Background and Aims: Emergence time, or the duration between incision closure and extubation, is costly nonoperative time. Efforts to improve operating room efficiency and identify trainee progress make such time intervals of interest. We sought to calculate the incidence of prolonged emergence (i.e., >15 min) for patients under the care of clinical anesthesia (CA) residents. We also sought to identify factors from resident training, medical history, anesthetic use, and anesthesia staffing, which affect emergence. Material and Methods: In this single-center, historical cohort study, perioperative information management systems provided data for surgical cases under resident care at a tertiary care center in the United States from 2006 to 2008. Using multiple logistic regression, the effects of variables on emergence was analyzed. Results: Of 7687 cases under the care of 27 residents, the incidence of prolonged emergence was 13.9%. Emergence prolongation decreased by month in training for 1st-year (CA-1) residents (r2 = 0.7, P< 0.001), but not for CA-2 and CA-3 residents. Mean patient emergence time differed among 27 residents (P < 0.01 for 58.4% or 205/351 paired comparisons). In a model restricted to 1st-year residents, patient male gender, American Society of Anesthesiologists (ASA) physical status >II, emergency surgical case, operative duration ≥2 h, and paralytic agent use were associated with higher frequency of prolonged emergence, while sevoflurane or desflurane use was associated with lower frequency. Attending anesthesiologist handoff was not associated with longer emergence. Conclusion: Incidence of prolonged emergence from general anesthesia differed significantly among trainees, by resident training duration, and for patients with ASA >II. more...

BACKGROUND:Senior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in 'Airway', 'Circulation', 'Central venous catheter', and 'Pain management complications'. Non-technical skills are an integral component of team-based OR emergency management. METHODS:Prior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training. RESULTS:Post-PBL resident clinical management self- confidence improved (P more...

Introduction: Anesthesia residents are deemed competent based on subjective and objective metrics. Knowledge acquisition and procedural skill is often difficult to accurately measure. Inspecting tangible metrics of perioperative efficiency may provide a source for reliable evaluation., Methods: Retrospective case-log database review yielded 3072 surgical cases involving residents over 5 years. Primary variable investigated was the time from surgery completion to exit from operating room. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status (ASA PS) classification, and inpatient versus day surgery status., Results: After controlling for procedure duration time, inpatient status, ASA PS, surgeon, and attending anesthesiologist, resident training time had high statistical significance. In the fully adjusted model, 1 year of resident training was associated with a reduction in emergence time by 28 seconds. A 1-hour increase in procedure time was associated with an increase in emergence time of 34 seconds., Conclusions: Although a statistically significant correlation between anesthesia resident training time and emergence time was demonstrated, the clinical significance is likely low given the relatively small amount of actual time saved. We caution the value of using perioperative metrics (e.g., emergence time) for evaluating anesthesia resident competency, until such metrics have undergone significant validation., (© 2020 Society for Education in Anesthesia.) more...

Background: The role of the internet continues to expand, particularly in the realm of graduate medical education. Residency program directors commonly use websites to share information with applicants. As social media (SM) use grows, the role of residency-based SM accounts in recruiting prospective residents remains unclear., Objective: We sought to delineate which SM platforms prospective anesthesia residents have accounts and which platforms they use to research anesthesia residency programs., Methods: Following the results of the National Residency Match Program (NRMP) in March 2018, we anonymously surveyed anesthesiology resident candidates from all three Mayo Clinic residency sites and inquired about which SM platforms candidates maintain a profile, which they used to evaluate residencies, and to what degree the content influenced their decision., Results: A total of 219 surveys were distributed that resulted in 89 responses (40.6%, 89/219). Most respondents have a Facebook account (94.4%, 84/89) while Doximity was the most commonly used SM platform to research programs (86.5%, 77/89). Most respondents (52.8%, 47/89) felt the presence of a residency-based SM account had an impact on their evaluation of prospective programs. Most respondents (50.5%, 45/89) used an internet search to research programs, while a large percentage (42.7%, 38/89) used a combination of internet search engines and SM platforms., Conclusions: While an internet search was the most commonly used technique to research programs, many applicants also used SM platforms. Doximity was the most commonly SM platform, however, more applicants have Facebook accounts, suggesting programs can use this platform to reach prospective applicants., Competing Interests: The authors declare no conflicts of interest more...

Background: Previous studies have suggested the use of ultrasonography for more success in spinal anesthesia. The purpose of this study was to compare the effect of ultrasonography and traditional method on the success rate of spinal anesthesia by an anesthesia resident. Methods: In this clinical trial study, patients who were candidate for leg or lower abdominal surgery under spinal anesthesia and referred to Firoozgar and Rasoul-e-Akram hospitals in 2019 were randomly assigned to techniques: 1) common surface marking techniques and 2) the use of ultrasonography to find the spinal canal. The dural puncture success rate at the first needle entry attempt, time required for determining the needle entry site, time required for needle entry until CSF exit, number of needle redirection without complete skin exit, and needle entry after complete needle withdrawal in each group were measured and recorded. Results: The success rate of dural puncture at the first attempt of entry and the time required to determine the needle entry site in the ultrasonography group (55.2%) was significantly higher than that in Landmark group (21.4%) (P<0.05). The time required for needle entrance to CSF exit, the total procedure time for patients, the number of needles redirection without complete removal of the skin, and the number of needle entry after complete removal of the skin in the ultrasonography group was significantly lower than that in Landmark group (P<0.05). Conclusion: The use of ultrasonography in comparison with the traditional method has been effective on the success rate of spinal anesthesia by an anesthesia resident. [ABSTRACT FROM AUTHOR] more...

Background: Valid methods are needed to identify anesthesia resident performance gaps early in training. However, many assessment tools in medicine have not been properly validated. The authors designed and tested use of a behaviorally anchored scale, as part of a multiscenario simulation-based assessment system, to identify high- and low-performing residents with regard to domains of greatest concern to expert anesthesiology faculty., Methods: An expert faculty panel derived five key behavioral domains of interest by using a Delphi process (1) Synthesizes information to formulate a clear anesthetic plan; (2) Implements a plan based on changing conditions; (3) Demonstrates effective interpersonal and communication skills with patients and staff; (4) Identifies ways to improve performance; and (5) Recognizes own limits. Seven simulation scenarios spanning pre-to-postoperative encounters were used to assess performances of 22 first-year residents and 8 fellows from two institutions. Two of 10 trained faculty raters blinded to trainee program and training level scored each performance independently by using a behaviorally anchored rating scale. Residents, fellows, facilitators, and raters completed surveys., Results: Evidence supporting the reliability and validity of the assessment scores was procured, including a high generalizability coefficient (ρ = 0.81) and expected performance differences between first-year resident and fellow participants. A majority of trainees, facilitators, and raters judged the assessment to be useful, realistic, and representative of critical skills required for safe practice., Conclusion: The study provides initial evidence to support the validity of a simulation-based performance assessment system for identifying critical gaps in safe anesthesia resident performance early in training. more...

Objective To analyze the current status and occupational factors associated with breastfeeding continuation after maternity leave among female anesthesia residents in China. Methods Our study was based on a nationwide survey 'Breastfeeding and Work/Family Balance Among Female Anesthesiologists' conducted by Chinese Society of Anesthesiology, which was targeted to female anesthesia residents giving birthsince January 1, 2015.An anonymous online questionnaire was developed to collect basic information, breastfeeding practices and workload.The inclusion variables were screened using the akaike information criterion (AIC), with the event defined as 'termination of breastfeeding'.Occupational factors that may affect breastfeeding were included as explanatory variables and non-occupational related factors that may affect breastfeeding were also included in the model to adjust for potential confounding effects.Schoenfeld were used to assess whether the variables were satisfied for each explanatory variable, and for those that were not, the time-dependent covariate for that variable was added to the model, occupational factors affecting breastfeeding duration were analyzed using stepwise Cox regression. Results A total of 436 anesthesia residents from 29 provinces were included.According to the survey, 372(85.3%, 372/436) terminated breastfeeding, of which 268(72.0%, 268/372) ended breastfeeding early due to work, 419(96.1%, 419/436) significantly reduced breast milk after work, and 133(30.5%, 133/436) had no opportunity to breastfeed at work.Their median breastfeeding duration was 10(8, 12) months.Longer work experience at childbirth was associated with a higher risk of discontinuing breastfeeding (HR=1.09, 95% CI: 1.03-1.15, P=0.004).The following occupational factors were associated with a longer breastfeeding duration: prolonged maternity leave (HR=0.85, 95% CI: 0.78-0.93, P < 0.001), tertiary hospital (HR=0.56, 95% CI: 0.43-0.73, P < 0.001), more opportunities for breast pumping during worktime (HR=0.02, 95% CI: 0-0.08, P < 0.001) and reduced workload during the breastfeeding period (HR=0.47, 95% CI: 0.26-0.86, P=0.014). Conclusion Hospital administrators can make efforts to offer prolonged maternity leave, modified rotation plan, breastfeeding rooms, and breastfeeding breaks, which are beneficial to both maternal and fetal health. more...

The Accreditation Council for Graduate Medical Education requires that residency programs teach residents about handoffs and ensure their competence in this communication skill. Development of hand-off curricula for anesthesia residency programs is hindered by the paucity of evidence regarding how to conduct, teach, and evaluate handoffs in the various settings where anesthesia practitioners work. This narrative review draws from literature in anesthesia and other disciplines to provide recommendations for anesthesia resident hand-off curriculum development and evaluation. more...

Background: Three competing goals at academic medical centers are to increase efficiency, to optimize clinical care, and to train residents. The goal of this project was to compare day surgery operating room (OR) efficiency measures for anesthesiologists working alone, working with residents, and working with certified nurse anesthetists in a tertiary multisubspecialty teaching hospital to determine if trainees significantly impact OR efficiency., Methods: We retrospectively evaluated operating room times data for 2,427 day surgery cases, comparing first case on-time starts, anesthesia-controlled times, induction times, emergence times, and turnover times for the 3 anesthesiologist groups., Results: Compared to the solo anesthesiologist group, anesthesiologists working with residents had significantly longer induction, emergence, and total anesthesia-controlled times (20.2 ± 8.0 vs 18.4 ± 7.0 minutes). However, the anesthesiologists working with residents had more on-time starts (65% vs 53%) and lower turnover times 47.3 ± 13.6 vs 50.8 ± 14.5 minutes) than the solo anesthesiologist group., Conclusion: The pairing of anesthesiology residents with anesthesia staff has mixed effects on OR efficiency measures in a day surgery unit. more...

Remifentanil is a potent micro-opioid receptor agonist that produces intense analgesia. This anilidopiperidine analog of fentanyl was approved by the United States Food and Drug Administration and became commercially available in the United States in 1997. Because of its unique chemical structure, remifentanil must be reconstituted; it has a rapid onset, and because of ester hydrolysis, it has a rapid rate of degradation. Although remifentanil's package insert warns against the potential for addiction, because of its rapid rate of degradation there was little concern that health care workers would abuse this drug. Herein, we report a case of intranasal remifentanil abuse by an anesthesiology resident. more...