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A&A Practice Aug 2022With aging-associated obesity and osteoarthritis, anesthesiology trainees and their instructors face difficulties in identifying the surface anatomy and landmarks for...
With aging-associated obesity and osteoarthritis, anesthesiology trainees and their instructors face difficulties in identifying the surface anatomy and landmarks for spinal anesthesia, and successfully advancing the needle into the intrathecal space. Through a series of illustrations and instructions, this teaching tool suggests that using a spinal needle in the same way that a blind person uses a white cane may improve a trainee's ability to successfully perform a lumbar puncture. Reviewing the technique and instructions with the trainee before approaching the patient can minimize verbal instructions in the patient's presence and may lead to improved efficiency and trainee success.
Topics: Anesthesia, Spinal; Anesthesiology; Humans; Needles
PubMed: 35939359
DOI: 10.1213/XAA.0000000000001592 -
Anesthesiology Oct 2023
Topics: Anesthesia; Anesthesiology; Heart; Thorax
PubMed: 37698431
DOI: 10.1097/ALN.0000000000004648 -
Anesthesiology Jun 2022
Topics: Anesthesiology; Implementation Science; Quality Improvement
PubMed: 35405007
DOI: 10.1097/ALN.0000000000004206 -
Anesthesia and Analgesia Feb 2022Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with... (Review)
Review
Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with clear and significant public health relevance. Within anesthesiology, the traditional perspective of the field's health impact has focused on providing safe and effective intraoperative care, managing critical illness, and treating acute and chronic pain. However, there are limitations to such a framework for anesthesiology's public health impact, including the transient nature of acute care episodes such as the intraoperative period and critical illness, and a historical focus on analgesia alone-rather than the complex psychosocial milieu-for pain management. Due to the often episodic nature of anesthesiologists' interactions with patients, it remains challenging for anesthesiologists to achieve their full potential for broad impact and leadership within increasingly integrated health systems. To unlock this potential, anesthesiologists should cultivate new clinical, research, and administrative roles within the health system-transcending traditional missions, seeking interdepartmental collaborations, and taking measures to elevate anesthesiologists as dynamic and trusted leaders. This special article examines 3 core themes for how anesthesiologists can enhance their impact within the health care system and pursue new collaborative health missions with nonanesthesiologist clinicians, researchers, and administrative leaders. These themes include (1) reframing of traditional anesthesiologist missions toward a broader health system-wide context; (2) leveraging departmental and institutional support for professional career development; and (3) strategically prioritizing leadership attributes to enhance system-wide anesthesiologist contributions to improving overall patient health.
Topics: Anesthesiologists; Anesthesiology; Career Mobility; Humans; Leadership; Physician-Patient Relations
PubMed: 33684091
DOI: 10.1213/ANE.0000000000005428 -
Brazilian Journal of Anesthesiology... 2022Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and... (Review)
Review
INTRODUCTION AND OBJECTIVE
Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents.
METHODS
A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence".
RESULTS AND CONCLUSIONS
Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.
Topics: Anesthesiology; Brazil; Clinical Competence; Humans; Internship and Residency; Patient Safety
PubMed: 35124107
DOI: 10.1016/j.bjane.2021.06.029 -
Anesthesiology Oct 2021
Topics: Anesthesiologists; Anesthesiology; History, 20th Century; History, 21st Century; Humans; Translational Research, Biomedical
PubMed: 34499145
DOI: 10.1097/ALN.0000000000003927 -
BMC Medical Education May 2024Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology...
BACKGROUND
Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology Milestones. The aim of this study was to investigate the differences between resident self-assessments and faculty-assessments on Anesthesiology Milestones and the associated factors.
METHODS
This was a cross-sectional study conducted in a general tertiary university-affiliated hospital. We included anesthesia residents who were enrolled in the standardized residency training program in postgraduate year two and three at the time of the Milestone evaluation. We requested evaluations of competencies from both the Clinical Competency Committee faculty and the anesthesia residents themselves, utilizing the Chinese version of Anesthesiology Milestones in January 2023 and January 2024. The primary outcome was the differences between self- and faculty-assessments, calculated by subtracting the faculty-rated score from the self-rated score on each subcompetency.
RESULTS
A total of 46 and 42 residents were evaluated in year 2023 and 2024, respectively. The self-rated sum score was significantly higher than that rated by faculty [mean (standardized deviation): 120.39 (32.41) vs. 114.44 (23.71), P = 0.008 in paired t test] with an intraclass correlation coefficient of 0.55 [95% confidence interval (CI): 0.31 to 0.70]. The Bland-Altman plots revealed significant overestimation in patient care (bias 0.32, 95% CI: 0.05 to 0.60), practice-based learning and improvement (bias 0.45, 95% CI: 0.07 to 0.84), and professionalism (bias 0.37, 95% CI: 0.02 to 0.72). Ratings from residents with master's degrees (mean difference: -1.06, 95% CI: -1.80 to -0.32, P = 0.005) and doctorate degrees (mean difference: -1.14, 95% CI: -1.91 to -0.38, P = 0.003) were closer to the faculty-assessments than residents with bachelor's degrees. Compared with patient care, the differences between self- and faculty- rated scores were smaller in medical knowledge (mean difference: -0.18, 95% CI: -0.35 to -0.02, P = 0.031) and interpersonal and communication skills (mean difference: -0.41, 95% CI: -0.64 to -0.19, P < 0.001) in the generalized estimating equation logistic regression model.
CONCLUSIONS
This study revealed that residents tended to overestimate themselves, emphasizing the need to improve the accuracy of Milestones self-assessment. The differences between self- and faculty-assessments were associated with residents' degrees and domains of competency.
Topics: Cross-Sectional Studies; Humans; Internship and Residency; Self-Assessment; Anesthesiology; Clinical Competence; Faculty, Medical; Male; Female; Adult; Educational Measurement
PubMed: 38760807
DOI: 10.1186/s12909-024-05544-6 -
Anaesthesia Mar 2023
Topics: Humans; Anesthesia; Anesthesiology
PubMed: 35944281
DOI: 10.1111/anae.15830 -
Brazilian Journal of Anesthesiology... 2021In 2017, the Brazilian Society of Anesthesiology (SBA) and the National Medical Residency Committee (CNRM) presented a joint competence matrix to train and evaluate... (Review)
Review
In 2017, the Brazilian Society of Anesthesiology (SBA) and the National Medical Residency Committee (CNRM) presented a joint competence matrix to train and evaluate physicians specializing in Anesthesiology, which was enforced in 2019. The competency-based curriculum aims to train residents in relation to certain results, in that residents are considered capable when they are able to act in an appropriate and effective manner within certain standards of performance. Canada and the United States (US) also use competency-based curriculum to train their professionals. In Canada, the format is the basis for using an evaluation method known as Entrustable Professional Activities (EPA), in which the mentor assesses residents' capacity to perform certain tasks, classified in 5 levels. The US, in turn, uses Milestones as evaluation, in which competencies and sub-competencies are assessed according to residents' progress during training. The present article aims to describe and compare the different competency-based curriculum and the evaluation methods used in the three countries, and proposes a reflection on future paths for medical education in Anesthesiology in Brazil.
Topics: Anesthesiology; Brazil; Canada; Clinical Competence; Competency-Based Education; Humans; Internship and Residency; United States
PubMed: 33781575
DOI: 10.1016/j.bjane.2020.12.026 -
Current Opinion in Anaesthesiology Aug 2019Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be... (Review)
Review
PURPOSE OF REVIEW
Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education.
RECENT FINDINGS
Topics for the future include, but are not limited to, new medications, artificial intelligence and big data, monitoring depth of hypnosis, translational innovation and collaboration, demographic changes, financial driving forces, destination hubs, medical tourism, and new approaches to education training and self-management.
SUMMARY
Implementing new medical technologies for anesthesia outside the operating room will help to successfully master this ever evolving subspecialty. Anesthesiologists require specific preparation for the diverse settings that they will encounter during their training. In this rapidly changing field, cognitive fitness must be factored into teaching and evaluation of residents. We describe the most important topics to consider when educating anesthesiology residents, and highlight research that addresses upcoming challenges.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Anesthetics; Biomedical Technology; Diffusion of Innovation; Forecasting; Humans; Internship and Residency
PubMed: 31021895
DOI: 10.1097/ACO.0000000000000743