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Anesthesia and Analgesia Jun 2021Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of...
BACKGROUND
Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable professional activities (EPAs) represent a workplace-based method to assess the achievement of competency milestones at the point-of-care that can be applied to anesthesiology training in the United States.
METHODS
Experts in education and competency assessment were recruited to participate in a 6-step process using a modified Delphi method with iterative rounds to reach consensus on an entrustment scale, a list of EPAs and procedural skills, detailed definitions for each EPA, a mapping of the EPAs to the ACGME milestones, and a target level of entrustment for graduating US anesthesiology residents for each EPA and procedural skill. The defined EPAs and procedural skills were implemented using a website and mobile app. The assessment system was piloted at 7 anesthesiology residency programs. After 2 months, faculty were surveyed on their attitudes on usability and utility of the assessment system. The number of evaluations submitted per month was collected for 1 year.
RESULTS
Participants in EPA development included 18 education experts from 11 different programs. The Delphi rounds produced a final list of 20 EPAs, each differentiated as simple or complex, a defined entrustment scale, mapping of the EPAs to milestones, and graduation entrustment targets. A list of 159 procedural skills was similarly developed. Results of the faculty survey demonstrated favorable ratings on all questions regarding app usability as well as the utility of the app and EPA assessments. Over the 2-month pilot period, 1636 EPA and 1427 procedure assessments were submitted. All programs continued to use the app for the remainder of the academic year resulting in 12,641 submitted assessments.
CONCLUSIONS
A list of 20 anesthesiology EPAs and 159 procedural skills assessments were developed using a rigorous methodology to reach consensus among education experts. The assessments were pilot tested at 7 US anesthesiology residency programs demonstrating the feasibility of implementation using a mobile app and the ability to collect assessment data. Adoption at the pilot sites was variable; however, the use of the system was not mandatory for faculty or trainees at any site.
Topics: Anesthesiology; Humans; Internship and Residency; Pilot Projects; Professional Role; Program Development; Surveys and Questionnaires; United States
PubMed: 33661789
DOI: 10.1213/ANE.0000000000005434 -
Anesthesiology Clinics Jun 2018In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care.... (Review)
Review
In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments.
Topics: Anesthesiologists; Anesthesiology; Humans; Population Health; Quality of Health Care; Specialization; United States
PubMed: 29759290
DOI: 10.1016/j.anclin.2018.01.008 -
EMBO Reports Nov 2014
Topics: Amino Acid Sequence; Anesthesiology; Anesthetics; Animals; Drug Discovery; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Molecular Sequence Data; Sodium Channel Blockers; Sodium Channels
PubMed: 25312808
DOI: 10.15252/embr.201439593 -
British Journal of Anaesthesia Feb 2018Competency-based assessment tools are used in regional anaesthesia to measure the performance of study participants, trainees, and consultants. This narrative review was... (Review)
Review
Competency-based assessment tools are used in regional anaesthesia to measure the performance of study participants, trainees, and consultants. This narrative review was performed to appraise currently published assessment tools for regional anaesthesia. A literature search found 397 citations of which 28 peer-reviewed studies met the inclusion criteria of primary psychometric evaluation of assessment tools for regional anaesthesia. The included studies were diverse in the type of assessment and the skill set being assessed. The types of assessments included multiple-choice questions, hand-motion analysis, cumulative sum, visuospatial and psychomotor screening, checklists, and global rating scales. The skill sets that were assessed included holistic regional anaesthesia technical and non-technical performance observed at the bedside, to isolated part-tasks, such as needle tip visualisation under ultrasound. To evaluate validity and reliability, we compared the studies against published medical education consensus statements on ideal assessment tools. We discuss the relative merits of different tools when used to assess regional anaesthesia, the importance of psychometrically robust assessment tools in competency-based anaesthesia education, and directions for future education research in regional anaesthesia.
Topics: Anesthesia, Conduction; Anesthesiology; Clinical Competence; Educational Measurement; Humans; Psychometrics; Reproducibility of Results
PubMed: 29406175
DOI: 10.1016/j.bja.2017.09.007 -
European Journal of Anaesthesiology Jul 2019
Topics: Anesthesiology; Curriculum; Education, Medical; Europe; Humans
PubMed: 31742567
DOI: 10.1097/EJA.0000000000001023 -
Anesthesia and Analgesia Feb 2015For the dedicated anesthesiologist, a high level of expertise is needed to deliver good care to patients and to provide excellent service to surgeons, anesthesia... (Review)
Review
For the dedicated anesthesiologist, a high level of expertise is needed to deliver good care to patients and to provide excellent service to surgeons, anesthesia colleagues, and others. Expertise helps the anesthesiologist recover from difficult situations and generally makes the practice run more effectively. Expertise also contributes to quality of life through higher self-esteem and long-term career satisfaction. We begin by reviewing the attributes that characterize expert performance and discussing how a specific training format, known as deliberate practice, contributes to acquisition and maintenance of expertise. Deliberate practice involves rehearsal of specific tasks to mastery, ideally under the eye of a mentor to provide feedback. This amounts to an orchestrated effort to improve that enables trainees to progress to expert levels of performance. With few exceptions, people who become recognized experts have pursued deliberate practice on the order of 4 hours per day for 10 to 15 years. In contrast, those who practice their profession in a rote manner see their skills plateau well below the level of top performers. Anesthesiology instruction with attending supervision provides all of the necessary components for deliberate practice, and it can be effective in anesthesia. Using deliberate practice in teaching requires organization in selecting training topics, effort in challenging students to excel, and skill in providing feedback. In this article, we discuss how educational programs can implement deliberate practice in anesthesiology training, review resources for instructors, and suggest how anesthesiologists can continue the practice after residency.
Topics: Anesthesiology; Clinical Competence; Humans; Internship and Residency
PubMed: 25602455
DOI: 10.1213/ANE.0000000000000526 -
International Anesthesiology Clinics 2016
Review
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Humans; Models, Organizational
PubMed: 27285074
DOI: 10.1097/AIA.0000000000000101 -
Anesthesiology Jul 2021
Topics: Anesthesiology; Internship and Residency; Motivation
PubMed: 34046660
DOI: 10.1097/ALN.0000000000003809 -
Anesthesiology Clinics Jun 2018Since the publication of "To Err is Human" in 1999, substantial efforts have been made within the health care industry to improve quality and patient safety. Although... (Review)
Review
Since the publication of "To Err is Human" in 1999, substantial efforts have been made within the health care industry to improve quality and patient safety. Although improvements have been made, recent estimates continue to indicate the need for a marked change in approach. In this article, the authors discuss the concepts and characteristics of high reliability organizations, safety culture, and clinical microsystems. The health care delivery system must move beyond current quality and patient safety approaches and fully engage in these new concepts to transform health care system performance.
Topics: Anesthesiology; Humans; Medical Errors; Patient Safety; Quality of Health Care; Safety Management; United States
PubMed: 29759284
DOI: 10.1016/j.anclin.2018.01.010 -
Anesthesia and Analgesia May 2020
Review
Topics: Anesthesiology; Aviation; Brain-Computer Interfaces; Forecasting; Humans; Space Flight
PubMed: 32287132
DOI: 10.1213/ANE.0000000000004628