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British Journal of Anaesthesia Oct 2009A key aspect of the practice of anaesthesia is the ability to perform practical procedures efficiently and safely. Decreased working hours during training, an increasing... (Review)
Review
A key aspect of the practice of anaesthesia is the ability to perform practical procedures efficiently and safely. Decreased working hours during training, an increasing focus on patient safety, and greater accountability have resulted in a paradigm shift in medical education. The resulting international trend towards competency-based training demands robust methods of evaluation of all domains of learning. The assessment of procedural skills in anaesthesia is poor compared with other domains of learning and has fallen behind surgical fields. Logbooks and procedure lists are best suited to providing information regarding likely opportunities within training programmes. Retrospective global scoring and direct observation without specific criteria are unreliable. The current best evidence for a gold standard for assessment of procedural skills in anaesthesia consists of a combination of previously validated checklists and global rating scales, used prospectively by a trained observer, for a procedure performed in an actual patient. Future research should include core assessment parameters to ensure methodological rigor and facilitate robust comparisons with other studies: (i) reliability, (ii) validity, (iii) feasibility, (iv) cost-effectiveness, and (v) comprehensiveness with varying levels of difficulty. Simulation may become a key part of the future of formative and summative skills assessment in anaesthesia; however, research is required to develop and test simulators that are realistic enough to be suitable for use in high-stakes evaluation.
Topics: Anesthesia; Anesthesiology; Clinical Competence; Education, Medical, Graduate; Educational Measurement; Humans; Patient Simulation
PubMed: 19720612
DOI: 10.1093/bja/aep241 -
British Journal of Anaesthesia May 2012
Topics: Anesthesiology; Health Services Needs and Demand; Humans; Perioperative Care; Physician's Role
PubMed: 22499744
DOI: 10.1093/bja/aes124 -
Scandinavian Journal of Trauma,... Jul 2022Medical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Medical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated medical emergencies by experienced teams. In this randomized trial we evaluated guideline adherence and treatment efficacy in simulated medical emergencies managed by residents with and without CA.
METHODS
Physicians attending educational courses executed simulated medical emergencies. Teams were randomly assigned to manage emergencies with or without CA. Primary outcome was risk reduction of essential working steps. Secondary outcomes included prior experience in emergency medicine and CA, perceptions of usefulness, clinical relevance, acceptability, and accuracy in CA selection. Participants were grouped as "medical" (internal medicine and neurology) and "perioperative" (anesthesia and surgery) regarding their specialty. The study was designed as a prospective randomized single-blind study that was approved by the ethical committee of the University Duisburg-Essen (19-8966-BO).
TRIAL REGISTRATION
DRKS, DRKS00024781. Registered 16 March 2021-Retrospectively registered, http://www.drks.de/DRKS00024781 .
RESULTS
Eighty teams participated in 240 simulated medical emergencies. Cognitive aid usage led to 9% absolute and 15% relative risk reduction. Per protocol analysis showed 17% absolute and 28% relative risk reduction. Wrong CA were used in 4%. Cognitive aids were judged as helpful by 94% of the participants. Teams performed significantly better when emergency CA were available (p < 0.05 for successful completion of critical work steps). Stress reduction using CA was more likely in "medical" than in "perioperative" subspecialties (3.7 ± 1.2 vs. 2.9 ± 1.2, p < 0.05).
CONCLUSIONS
In a high-fidelity simulation study, CA usage was associated with significant reduction of incorrect working steps in medical emergencies management and was characterized by high acceptance. These findings suggest that CA for medical emergencies may have the potential to improve emergency care.
Topics: Anesthesiology; Cognition; Emergencies; Humans; Prospective Studies; Single-Blind Method
PubMed: 35820939
DOI: 10.1186/s13049-022-01028-y -
Anaesthesia Jan 2000
Topics: Anesthesiology; Anesthetics; Equipment Design; Equipment Safety; History, 20th Century; Humans; United Kingdom
PubMed: 10594424
DOI: 10.1046/j.1365-2044.2000.01283.x -
Anesthesiology Mar 2014
Topics: Anesthesiology; Equipment Design; Humans; Medication Errors; Patient Safety; Perioperative Period; Technology; United States
PubMed: 24406798
DOI: 10.1097/ALN.0000000000000127 -
Anesthesiology Jan 2014The Accreditation Council for Graduate Medical Education is transitioning to a competency-based system with milestones to measure progress and define success of...
The Accreditation Council for Graduate Medical Education is transitioning to a competency-based system with milestones to measure progress and define success of residents. The confines of the time-based residency will be relaxed. Curriculum must be redesigned and assessments will need to be precise and in-depth. Core anesthesiology faculty will be identified and will be the "trained observers" of the residents' progress. There will be logistic challenges requiring creative management by program directors. There may be residents who achieve "expert" status earlier than the required 36 months of clinical anesthesia education, whereas others may struggle to achieve acceptable status and will require additional education time. Faculty must accept both extremes without judgment. Innovative new educational opportunities will need to be created for fast learners. Finally, it will be important that residents embrace this change. This will require programs to clearly define the specific aims and measurement endpoints for advancement and success.
Topics: Accreditation; Anesthesiology; Competency-Based Education; Curriculum; Education, Medical, Graduate; Educational Measurement; Faculty; Faculty, Medical; History, 20th Century; Humans; Internship and Residency
PubMed: 24158052
DOI: 10.1097/ALN.0000000000000039 -
Anesthesiology Jan 2013
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Journal of Cardiothoracic and Vascular... Sep 2022
Topics: Anesthesia, Cardiac Procedures; Anesthesiology; Critical Care; Curriculum; Fellowships and Scholarships; Humans; Internship and Residency
PubMed: 35718622
DOI: 10.1053/j.jvca.2022.05.022 -
Anesthesiology Sep 2020Automated medical technology is becoming an integral part of routine anesthetic practice. Automated technologies can improve patient safety, but may create new workflows... (Review)
Review
Automated medical technology is becoming an integral part of routine anesthetic practice. Automated technologies can improve patient safety, but may create new workflows with potentially surprising adverse consequences and cognitive errors that must be addressed before these technologies are adopted into clinical practice. Industries such as aviation and nuclear power have developed techniques to mitigate the unintended consequences of automation, including automation bias, skill loss, and system failures. In order to maximize the benefits of automated technology, clinicians should receive training in human-system interaction including topics such as vigilance, management of system failures, and maintaining manual skills. Medical device manufacturers now evaluate usability of equipment using the principles of human performance and should be encouraged to develop comprehensive training materials that describe possible system failures. Additional research in human-system interaction can improve the ways in which automated medical devices communicate with clinicians. These steps will ensure that medical practitioners can effectively use these new devices while being ready to assume manual control when necessary and prepare us for a future that includes automated health care.
Topics: Anesthesiology; Automation; Equipment and Supplies; Humans; Medical Records; Operating Rooms; Patient Safety
PubMed: 32472805
DOI: 10.1097/ALN.0000000000003385 -
Minerva Anestesiologica May 2011Anesthesiology as a specialty has made numerous prescient commitments to better patient care. Physicians entering residency are reaching the zenith of their educational... (Review)
Review
Anesthesiology as a specialty has made numerous prescient commitments to better patient care. Physicians entering residency are reaching the zenith of their educational odyssey and primarily acquire knowledge and skill through active involvement. Simulation training and associated assessment offers a chance for active involvement to the learner. The goal of the training is to accelerate skill acquisition, improve skill retention and reduce the extinction of skills. Simulation training programs have been shown to increase the skill of anesthesiologists. This increase in skill is expected to translate to evidence of improved patient care. Direct evidence that simulation directly improves patient care continues to be difficult to establish. In the future, the intuitive benefit of simulation as a means to improve the safety and quality of patient care is likely to become established by clinical research.
Topics: Anesthesia; Anesthesiology; Clinical Competence; Communication; Educational Measurement; Humans; Internship and Residency; Judgment; Patient Care Team; Patient Simulation
PubMed: 21540808
DOI: No ID Found