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Vasoplegic syndrome occurs relatively frequently in cardiac surgery, liver transplant, major noncardiac surgery, in post-return of spontaneous circulation situations, and in pateints with sepsis. It is paramount for the anesthesiologist to understand both the pathophysiology of vasoplegia and the different treatment strategies available for rescuing a patient from life-threatening hypotension.

BACKGROUND The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of weekday operating room (OR) clinical duties existed at our institution, leaving on-call residents to independently decide daily relief order. We developed an automated decision support tool (DST) to improve equitable decision making for clinical relief and assessed its impact on real and perceived relief equity. METHODS The DST sent a daily e-mail to the senior resident responsible for relief decisions. It contained a prioritized relief list of noncall residents who worked in the OR beyond 5 PM the prior clinical day. We assessed actual relief equity using the number of times a resident worked in the OR past 5:30 PM on 2 consecutive weekdays as our outcome, adjusting for the mean number of open ORs each day between 5:00 PM and 6:59 PM in our main OR areas. We analyzed 14 months of data before implementation and 16 months of data after implementation. We assessed perceived relief equity before and after implementation using a questionnaire. RESULTS After implementing the DST, the percentage of residents held 2 consecutive weekdays over the total of resident days worked decreased from 1.33% to 0.43%. The percentage of residents held beyond 5:30 PM on any given day decreased from 18.09% to 12.64%. Segmented regression analysis indicated that implementation of the DST was associated with a reduction in biweekly time series of residents kept late 2 days in a row, independent of the mean number of ORs in use. Surveyed residents reported the DST aided their ability to make equitable relief decisions (pre 60% versus post 94%; P = .0003). Eighty-five percent of residents strongly agreed that a prioritized relief list based on prior day work hours after 5 PM aided their decision making. After implementation, residents reported fewer instances of working past 5 PM within the past month (P < .005). CONCLUSIONS A DST systematizing the relief process for anesthesiology residents was associated with a lower frequency of residents working beyond 5:30 PM in the OR on 2 consecutive days. The DST improved the perceived ability to make equitable relief decisions by on-call senior residents and residents being relieved. Success with this tool allows for broader applications in resident education, enabling enhanced monitoring of resident experiences and support for OR assignment decisions.

Purpose: Many US medical schools have adopted learning communities to provide a framework for advising and teaching functions. Faculty who participate in learning communities often have additional educator roles. Defining potential conflicts of interest (COIs) among these roles is an important consideration for schools with existing learning communities and those looking to develop them, both for transparency with students and also to comply with regulatory requirements. Methods: A survey was sent to the institutional contact for each of the 42 Learning Communities Institute (LCI) member medical schools to assess faculty opinions about what roles potentially conflict. The survey asked the role of learning community faculty in summative and formative assessment of students and whether schools had existing policies around COIs in medical education. Results: In all, 35 (85%) LCI representatives responded; 30 (86%) respondents agreed or strongly agreed that learning community faculty should be permitted to evaluate their students for formative purposes, while 19 (54%) strongly agreed or agreed that learning community faculty should be permitted to evaluate their students in a way that contributes to a grade; 31 (89%) reported awareness of the accreditation standard ensuring “that medical students can obtain academic counseling from individuals who have no role in making assessment or promotion decisions about them,” but only 10 (29%) had a school policy about COIs in education. There was a wide range of responses about what roles potentially conflict with being a learning community faculty. Conclusion: The potential for COIs between learning community faculty and other educator roles concerns faculty at schools with learning communities, but most schools have not formally addressed these concerns.

Problem Some medical students are drawn to medical education as an area of academic specialization. However, few options exist for medical students who wish to build a scholarly foundation for future careers in medical education. Approach In 2011, Vanderbilt University School of Medicine (VUSM) and Peabody College of Education and Human Development at Vanderbilt University partnered to establish a novel dual-degree program that, through transfer of credit, allows students to graduate with both an MD and a master of education (MEd) degree in five years. The MD-MEd joint-degree program equips students with robust knowledge and skills related to general education while providing opportunities through independent studies and capstone projects to contextualize these ideas in medical education. Outcomes This innovation at Vanderbilt University demonstrates the feasibility of an MD-MEd joint-degree program. MD-MEd graduates' demonstrated commitment to medical education and credentials will allow them to take on greater educational responsibilities earlier in their careers and quickly gain experience. The three author participants feel their experiences allowed them to achieve desired competencies as educators. They have each gained early experience by chairing the Student Curriculum Committee and contributing to major curricular reform at VUSM. Next steps The authors plan to integrate specific medical education competencies into the program, which will require MD-MEd students to develop and demonstrate proficiency in the knowledge and skills expected of dedicated medical educators. Graduates' career trajectories will be tracked to explore whether they become medical educators, conduct educational research, and assume leadership positions.