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The Journal of Education in Perioperative Medicine : JEPM logoLink to The Journal of Education in Perioperative Medicine : JEPM
. 2009 Jul 1;11(2):E052.

Abstracts Presented at the Spring Meeting of the Society for Education in Anesthesia

PMCID: PMC4719555  PMID: 27175384
J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Evaluation of a Daily Debriefing Form Designed to Promote Didactic Communication and Competency-Based Resident Feedback

Ramon E Abola 1, Joy E Schabel 1, Ellen Steinberg 1, Rishimani Adsumelli 1

Learner Audience: Residency Program Directors, Faculty

Background: In a department survey evaluating our educational program, 0% of residents rated resident-attending communication as highly effective, and 0% of residents rated intraoperative teaching as adequate. Intraoperative teaching and resident feedback were identified as key components to effective resident-attending communication. A daily debriefing form was created and implemented to (1) enhance resident-attending didactic communication, and (2) provide frequent, formative competency-based resident feedback.

Needs Assessment: Evaluation of the daily debriefing form was performed to determine its effectiveness in improving didactic communication, intraoperative teaching and resident feedback.

Hypothesis: The completion of a daily debriefing form will enhance resident-attending didactic communication in the clinical setting and provide frequent, formative, competency-based feedback to the resident.

Curriculum Design: The Daily Debriefing Form was created and implemented to enhance resident-attending didactic communication and resident feedback. A departmental survey was completed by the faculty and residents to evaluate the effects of the daily debriefing form on our educational program eight months after initiating use of the form.

Outcome: 70% of faculty reported that the daily debriefing form increased their involvement in intraoperative teaching, increased intraoperative learning of the residents, and increased the amount of daily feedback that they provide the residents. 65% of residents surveyed reported adequate intraoperative teaching compared to 0% prior to implementation of the daily debriefing form. 65% of residents surveyed reported that use of the daily debriefing form has increased intraoperative teaching and resident learning. 95% of residents reported that the daily debriefing form has increased the amount of daily feedback that they have received from attending. Challenges to use of the daily debriefing form include appropriate grading scales and faculty compliance. Our department reports improvement in intraoperative teaching and resident feedback with the use of a daily debriefing form.

Daily Debriefing Form

Evaluator: Subject:

Rotation:

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General:

Today’s Date:

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Cases:

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Preop phonecall performed:

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Preop assessment & plans:

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Planned Discussion Topic(s):

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Discussed:

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Other Discussion Topics Today:

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Review of critical events:

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Checklists updated:

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Feedback:

Patient Care: (gather essential info; make diagnostic and therapeutic decisions; carry out plan; perform procedures; counsel/educate pts)

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Medical Knowledge: (demonstrate and apply knowledge)

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Practice-Based Learning and Improvement: (facilitate learning of students; use on-line med info; improve practice from experience; use IT to manage info; obtain evidence from studies)

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Interpersonal and Communication Skills: (work with others as part of team, effectively exchange info)

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Professionalism: (demonstrate respect, compassion, integrity, accountability, commitment to learn, informed consent; responsive to pts needs & age, gender, culture, disabilities)

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Systems- Based Practice: (practice cost-effective health care; advocate for quality pt care; understand how their practice affects health care system; know how to work with other providers to asses, coordinate and improve pt care)

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General:

“What did I learn today”?

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Can Assigning a Dedicated Resident Abstract Mentor Improve the Residents’ Scholarly Activities?

Rishimani Adsumelli 1, Joy Schabel 1, James Dilger 1, Christopher Gallagher 1

Learner Audience: Residency Program Directors

Background: The ACGME expects residents’ involvement in scholarly activities that lead to presentations at national meetings. In our program, a few residents were actively involved in research under the guidance of a mentor, but the majority of the residents had no experience in presenting at national meetings. The leadership of our residency program sought to create an academic culture to improve residents’ participation in scholarly activities that lead to presentations at national meetings.

Needs Assessment: There was poor resident participation in scholarly activities that resulted in presentations at national meetings.

Hypothesis: A dedicated resident abstract mentor, separate from a research mentor, can improve the scholarly activities of residents at national meetings.

Curriculum Design: A faculty member was assigned as the “Resident Abstract Mentor” in February 2008. The initial focus for residents’ scholarly participation was abstracts of medically challenging cases. The rationale being that the residents feel more motivated when they were personally responsible for the clinical management. The mentor took the following initiatives. 1. Periodic emails to faculty and residents to actively seek medically challenging cases. 2. Periodic emails to residents regarding deadlines for upcoming meetings. 3. Informal meetings with the residents to help with writing abstracts and subsequently posters.

Outcome: In 2008, the number of residents who presented at national meeting doubled when compared to previous years, even though the total number of the presentations from the department remained the same. (Table 1). A total of 12 presentations involved residents; 10 of which were medically challenging cases. The appointment of a dedicated resident mentor for abstracts and focus on case reports has led to a significant surge in our residents’ scholarly activity. The success of our approach may be relevant for other programs in their effort to follow the ACGME expectations regarding the scholarly activities of residents.

Table 1.

Year Number of Presentations at national meetings Number of residents involved
2003 19 1
2004 14 2
2005 25 4
2006 24 4
2007 26 4
2008 23 9
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J Educ Perioper Med. 2009 Jul 1;11(2):E052.

International Anesthesia Training Develops ACGME Competencies While Encouraging Participation in International Healthcare Service

John Algren 1, Mark Newton 1, Daniel Nahrwold 1, Michael Higgins 1

Learner Audience:Anesthesiology Faculty, Residents and Fellows

Background: International medical missions provide extraordinary training opportunities for residents, particularly in the ACGME competencies concerning professionalism, cultural diversity, and interpersonal and communication skills. In addition, voluntary participation by anesthesiologists on such missions is essential for the provision of safe and effective perioperative care and is encouraged by philanthropic and religious organizations as well as professional societies and educational institutions.

Needs Assessment: Many current residents, faculty members, and residency program applicants have prior experience and express strong interest in participating in international healthcare missions.

Hypothesis: International anesthesia training immerses residents in a foreign culture, dramatically demonstrating the importance of competence in cultural diversity and effective interpersonal and communication skills, while also encouraging fundamental principles of professionalism.

Curriculum Design: The Vanderbilt International Anesthesia (VIA) clinical rotation provides an extraordinary opportunity for residents to develop ACGME competencies while training in an international medical environment. The VIA program, under the direction of faculty members with extensive experience in international service, currently offers clinical rotations ranging from two to four weeks in Guatemala, Nigeria and Kenya. Vanderbilt faculty members supervise and teach residents at VIA sites. This experience expands residents’ awareness and understanding of cultural diversity, improving their ability to function in culturally diverse environments. Working in hospitals with limited resources challenges residents’ preexisting expectations and priorities, often leading to greater appreciation and better utilization of healthcare resources upon returning home. Residents share their expertise both as practitioners and teachers, thereby, enjoying the personal gratification of service to patients as well as students. Furthermore, residents learn perioperative patient care and management of anesthesia in a resource poor environment, commonly caring for patients with advanced diseases.

Outcome: Resident interest will be assessed by incidence of participation during residency followed by subsequent participation in international service missions after graduation. Standard residency program evaluation instruments are used to assess the clinical rotation as well as resident and faculty performance.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Bringing Anesthesia Expertise to International Volunteer Programs

Karen Boretsky 1, David G Metro 1, Robert Boretsky 1, Peter Davis 1

Learner audience: CA-3 residents

Background: Many developing countries lack adequate manpower and expertise to provide basic surgical services and, as the result, there are increasing numbers of American surgical teams traveling abroad to assist with such services. Anesthesiology expertise is critical to the safety and success of such missions.

Needs Assessment: There is no established formal education available to prepare anesthesiologists to take part in international volunteer surgical efforts in spite of growing global demand.

Curriculum Design The primary goal is to achieve a predictable and reproducible experience with an emphasis on high standards of care in a safe environment. A liaison was formed with a local, Pittsburgh based surgical volunteer organization whose resources included; experience, a Director willing to work with our organization, a good reputation, 5 trips annually and a local supply warehouse. A curriculum was developed emphasizing personal health and safety, advance planning, country specific issues relating to general health of the population, health care availability and resources, cultural nuances, unique co-morbid conditions, strict adherence to ASA guidelines and the importance of team dynamics. (table 1). A timeline in which to present the information was developed. (table 2). All supervising faculty have experience in both pediatric anesthesia and international missions. Resident selection is based not only on general anesthesia knowledge and clinical performance but also on disposition, attitude and flexibility. A DVD containing resource materials including websites and pertinent literature is is created and available for each trip. This rotation is ACGME-RRC approved for credit and all resident funding is provided by the UPMC Department of Anesthesiology. No trips are undertaken to countries when US State Department advisories against such travel are in effect.

Table 1.

Curriculum:

  1. Personal health and safety

  2. Cultural Considerations

  3. Site specific health issues

    1. General health of population

    2. Health Care System

  4. Topics in Volunteerism

  5. Pediatric Anesthetic Risk Data

  6. Specific Surgical Problems

  7. Trip Preparation

  8. ASA Practice Guidelines

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Table 1.

Timeline

  1. Initial clinical anesthesiology at a specialized pediatric hospital

    1. Review and enhancement of pediatric anesthesia knowledge.

  2. Ongoing meetings with faculty mentor for didactic sessions.

  3. Prior to departure

    1. Meet with local team members to discuss trip planning

    2. Secure necessary equipment and supplies.

  4. Clinical work at international site.

    1. Evaluating potential surgical candidates,

    2. Create and supply operating suite,

    3. Perioperative and intraoperative clinical anesthesia care.

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Outcome: Implementation of an ACGME-RRC approved rotation that integrates didactic teaching and supervised clinical experience to prepare residents to provide anesthesia expertise as members of international surgical teams.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Analysis of Research: Significance, Variables, Data

B K Bulibek 1, WH Folger 1

Learner Audience: Anesthesiology residents

Background: Statistics has been viewed as too complicated to understand and evaluate. Whatever is presented is accepted as valid. Statistics is thought to be about numbers; really it is about logical reasoning.

Needs Assessment: A specific teaching program is needed to help the resident analyze scientific publications. Organization of the research design and statistics will help in the evaluation of papers.

Hypothesis: Analyzing the data and appropriate statistic makes evaluation of scientific papers understandable.

Curriculum Design: Data Analysis: 1) Significance vs Non-significance: Any significance or non-significance reported in the Results section are analyzed for accuracy and sample size. 2) Independent vs Dependent: The independent (factor) and dependent variables (reponse) are identified to establish the objective of the study. 3) Nominal vs Continuous: The independent and dependent variables are labeled by whether they are names, such as alive or dead, or numbers, such as blood pressures. 4) Null vs Research: A null hypothesis statement is constructed to clarify the logic of the research. Statistical Analysis: 5) Parametric vs Non-parametric: The dependent variable determines whether to use a parametric statistic for continuous data or non-parametric statistic for nominal data. Continuous data are normally distributed, equal in variance, and independently sampled. 6) Independent statistic: The number of levels of a single factor determines whether to use a t-test or ANOVA. The number of factors determines whether to use ANOVA or multiple regression. 7) Dependent statistic: The number of dependent variables determines whether to use ANOVA, MANOVA, or multiple regression. 8) Correlation: The statistics described in last paragraph of Methods section should correlate with the statistic suggested by analysis. Significant values of continuous data are verified substituting sample numbers, means, and standard deviations in Glantz’s statistical program. For non-significant values, a sample size analysis is performed for each dependent variable.

Outcome: The resident will have a logical approach to analyzing a scientific paper. He will know how to break the data and statistic analysis steps into smaller components.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Questions are the Answer to Understanding

B K Bulibek 1, W H Folger 1

Learner Audience: Anesthesiology residents in lectures and in clinical situations.

Background: The resident is encouraged to read more. Frequently what he reads does not relate the basic and clinical sciences to what he read. He learns factual answers. Formulating questions requires acquiring factual knowledge and thinking about it at a deeper level in order to understand “how” and “why” the facts interrelate.

Needs Assessment: A specific learning program is needed to help the resident learn to ask questions. The resident needs to learn to ask the correct questions to facilitate competence in-depth.

Hypothesis: Asking the correct questions takes resident learning to the level of understanding.

Curriculum Design: 1) Knowledge Questions: These are ‘what” questions. First, the resident is given a fact (answer) from his reading or clinical situation. Then the resident is encouraged to ask any other “what” questions stimulated by this fact (answer). For example, a current of electrons causes the depolarization of the nerve and subsequent twitch of the muscle with the nerve stimulator. What is the amplitude of the current in milliamps that should be used? 40 mA in the normal patient. What is the best location for the nerve stimulator? Ulnar nerve. 2) Skill Questions: These are “how” questions. They give the steps in a process. For example, how is the appropriate current evaluated clinically? Before muscle relaxant is given. 3) Competence: Knowledge and skills are competence; however, competence may not mean understanding. 4) Understanding Questions: These relate knowledge and skill (competence) to the basic and clinical sciences. They are “why” questions. For example, why is 40 mA the correct current amplitude? 40 mA of current releases the “easily released acetylcholine (Ach)”; higher currents release the “reserve stores of Ach” causing an over-estimation of the muscle relaxant dose that is needed.

Outcome: The resident will know how to ask the questions needed to gain competence and understanding. He will understand a process which will relate his knowledge to the basic and clinical sciences.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

A Comprehensive But Simple Method to Manage and Track Resident Knowledge and Skill Acquisition during Pediatric Anesthesia Training

Destiny Chau 1, Rae Brown 1

Learner audience: Anesthesiology training program in an academic medical center

Background: Information concerning the management of patients and the development of skills is imparted in a number of different ways during residency training, including manuals, lectures and journal clubs. Documentation of the acquisition of knowledge and skills during subspecialty training has been a problem. Defining the extent that information is presented to each individual resident is a complex issue and requires substantial data gathering. We have struggled with this issue.

As a solution we have created a spreadsheet program that allows a program director or the head of a subspecialty rotation to determine: 1. Whether all aspects of a given curriculum are covered in some way within the residency-training program, 2. The extent to which individual residents avail themselves of the information as it is presented and, 3. The extent that the curriculum is being carried to all of the residents of the program. Data that are gathered from the results of in training exams can be compared with the curriculum to assure that all salient aspects of the subspecialty are covered. Data from the spreadsheet program allow us to assess the success or failure of individual methods of presenting material. For the residents, this program facilitates self-assessment of their skills and knowledge for the scope of the subspecialty throughout the entire residency and consequently it encourages independence for managing their individual learning.

Outcome: Through the use of this spreadsheet program, we are better able to manage the knowledge that needs to be transferred to residents during the training program. It also allows us to determine the best practices for the transfer of this knowledge by evaluating resident preference and objective test scores.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Pediatric Anesthesia for the CA-1 Resident

Rupa J Dainer 1, Ira Todd Cohen 1

Learner Audience: Resident – Clinical Anesthesia, Year 1

Background: Pediatric anesthesia is a challenging subspecialty that requires substantial preparation to maximize the educational benefit. Many anesthesia residency programs introduce pediatric anesthesia to residents at the CA-2 level. This often consists of a two-month rotation that may be the entirety of their pediatric anesthesia training, designed to prepare the resident to practice basic pediatric anesthesia as a consultant upon graduation and board certification.

Needs Assessment: It has been noted that the knowledge and performance of residents from programs that offer minimal exposure to pediatric anesthesia are superior to that of residents from programs offering no exposure. Discussions with the Children’s faculty and review of anonymous resident end-of-rotation evaluations of clinical and didactic experiences support this observation. The differences noted between the two groups of residents underscored the need for improved preparation prior to starting the subspecialty rotation.

Hypothesis: A structured curriculum for all CA-1s prior to their pediatric rotation will improve both the clinical and written exam performance of trainees.

Curriculum Design: Review of published pediatric anesthesia fellowship curricula and Children’s faculty input were used in the design of the curriculum. Content, which includes the basics of pediatric anesthesia as outlined by the Society for Pediatric Anesthesia and Cote’s Practice of Anesthesia for Infants and Children, is to be presented in lecture and problem-based learning formats. Supplementary reading material will be provided prior to the intervention. Learner evaluation will use a pediatric anesthesia quiz, consisting of questions culled from prior published written board examination questions, in-service scores (pediatric subsection) from the beginning of the CA-1 year and at the end of CA-1 and CA-2 years, and pediatric subspecialty rotation evaluations.

Outcome: The effectiveness of the curriculum will be assessed by tracking changes in in-service scores, the pediatric anesthesia quiz, and clinical assessments by Children’s faculty. The proposed curriculum is anticipated to improve both the Medical Knowledge and Patient Care performance of future residents rotating in pediatric anesthesia. If successful, this curriculum could be applied to programs with and without separate pediatric facilities.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Impact of Thromboelastography Workshop in Treating Coagulopathy by Trainees

Jamey E Eklund 1, Shushma Aggarwal 1

Learner Audience: Anesthesiology resident physicians

Background: The improper treatment of coagulopathy can harm patients, depletes the blood product supply, and is a financial burden. To appropriately use blood products, providers must accurately determine the patient’s coagulation status. Conventional tests identify the quantitative function of coagulation factors and are time-consuming. Thromboelastography (TEG), a method of qualitatively determining whole blood coagulation, is performed in the operating room with results available in minutes.

Needs Assessment: In complex surgeries such as liver transplantation, major trauma, and vascular cases, patients may require massive blood transfusions. Quick and accurate diagnosis of coagulopathy and frequent monitoring are critical to optimal management. When performing a TEG, error can be introduced at each step. Flawed results may lead to improper treatment, thus comprehensive training of the device operators is necessary.

Hypothesis: We hypothesize that by attending the TEG workshop, trainees will be more willing to perform TEG, correlate TEG findings to the clinical scenario, and administer blood products based on evidence rather than empirically.

Curriculum Design: Since simulation is commonly utilized to teach and assess skills at our institution, we developed a simulation workshop to teach TEG. After obtaining an IRB-exemption, CA-1, CA-2, and CA-3 residents attended a 90-minute workshop conducted by an attending anesthesiologist and a resident: a 15-minute introductory lecture followed by a 75-minute hands-on experience operating the TEG machine. Trainees received a manual of problem-based scenarios utilizing TEG, created by the resident leading the workshop. Pre- and post-course quizzes (10 questions) were given to ascertain knowledge of coagulation cascade, thromboelastography, and transfusion therapy. Trainees also assessed their confidence in using TEG (score range from 0-30) to diagnose and treat coagulopathy. Workshop feedback was reviewed.

Outcome: Twenty-nine residents completed the TEG workshop, pre-and post-course quizzes, and pre- and post-course self-confidence evaluations. Resident feedback was extremely positive. The average pre-course quiz score increased from 8.28 to 9.54 post-course. The average confidence score increased from 16.7 pre-course to 20.8 post-course.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

An Anesthesiology Clerkship for General Medical Education

Tammy Y Euliano 1

Learner Audience: (context/setting) 4th year medical students

Background: Compulsory anesthesiology exposure during UGME is uncommon in the US. According to the AAMC Curriculum Directory1, only 27 of 126 medical schools required an anesthesiology clerkship last year. Reasons to sponsor a clerkship include recruitment into the specialty and education of all physicians. While the former proves relatively ineffective, anesthesiologists have much to contribute to general medical education.

Needs Assessment: The “general medical education” focus at UF led to substantial evolution of our required anesthesiology clerkship over the last several years, culminating in a 4th year 2-week clerkship entitled, “Life Support Skills & Perioperative Medicine.” In 2005-06 student comments regarding relevance for their chosen careers prompted development of a novel curriculum for students not pursuing anesthesiology, including personalized learning objectives (PLO) and formative on-line quizzes.

Hypothesis: We hypothesized an improved course, as reflected by student comments and course evaluations.

Curriculum Design: We developed a list of topics of broad interest that anesthesiologists teach well, but which are not well-addressed elsewhere. We then assigned values to each topic for each field of medicine (Table 1). Students completed a pre-course survey rating each topic for perceived importance and current level of understanding. Software generated a personalized letter with learning objectives and reading assignments based on the greater of their perception or Table 1. At the end of the clerkship students rated the PLO on a 5-point Likert scale (poor-to-excellent)

Table 1.

Assigned Topic Relevance based on Career Choice

Preop Preparation Airway Eval Vascular Access & Fluid Mgmt Basics of Conscious Sedation Basics of Reg Anes Basics of Gen Anes Acute Decompensation mgmt Acute pain mgmt Chronic pain mgmt Non-invasive monitors Invasive monitors CV/pulm phys ABG analysis Mech vent
Dermatology 3 3 2 4 2 2 3 3 3 3 2 2 2 2
Emergency Medicine 3 4 4 4 3 3 4 4 3 4 4 4 4 4
Family Practice 4 4 3 4 3 2 4 4 4 4 3 4 4 3
General Surgery 4 4 4 4 4 4 4 4 3 4 4 4 4 4
Internal Medicine 4 4 4 4 3 2 4 4 4 4 4 4 4 4
Neurology 3 3 3 3 3 3 4 4 4 4 3 4 4 4
Neurosurgery 4 4 4 4 3 4 4 4 4 4 4 4 4 4
Nuclear Medicine 3 3 2 4 2 2 4 3 4 4 2 3 2 2
Obstetrics-Gynecology 4 4 4 3 4 3 4 4 4 4 3 4 4 3
Ophthalmology 4 3 3 4 3 3 3 3 2 3 2 3 2 2
Orthopedic Surgery 4 4 4 4 4 4 4 4 4 4 4 4 4 3
Otolaryngology 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Pathology 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Pediatrics 4 4 4 4 3 2 4 4 3 4 3 4 4 3
Plastic Surgery 4 4 4 4 4 4 4 4 2 4 2 4 4 3
PM&R 2 3 3 3 3 2 4 4 4 3 2 4 3 2
Psychiatry 2 3 2 3 2 2 4 3 4 3 2 3 2 2
Radiation Oncology 2 3 2 2 2 2 2 3 4 3 2 3 2 2
Radiology 3 3 3 4 2 2 3 3 2 3 3 3 2 2
Urology 4 4 4 4 3 4 4 4 3 4 4 4 4 4
Other 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Not sure 3 3 3 3 3 3 3 3 3 3 3 3 3 3
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Outcome: Data analysis was deemed exempt by the IRB. Pre-course surveys were completed by 95/103 students (92%), representing all non-anesthesiology fields of study. Students rated the PLO 3.9 with 76% very good or excellent. There were positive comments, e.g. “…great job of tailoring the clerkship to meet our future careers; and I really appreciated [you] taking a vested interest in my goals.” However the overall clerkship evaluation remained unchanged at 4.1. Altering the final exam to match the PLO might increase their perceived value.

Footnotes

1

http://www.aamc.org/meded/curric/start.htm accessed October 8, 2008

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Creating a Highly Specific Letter of Reference

W H Folger 1, JP Ouanes 1

Learner Audience: Anesthesiology residents

Background: Most letters of reference are very general in their scope. The resident asks an attending for a recommendation, and no more input is given by the resident to the attending. The resident’s knowledge and skills can be verified to show that he is competent. His personality can be generally evaluated to show he can work with other people. This is appropriate but is lacking in specificity.

Needs Assessment: A specific learning program is needed to help the resident provide the attending with input from the resident to write a more specific recommendation.

Hypothesis: Documenting a resident’s talents, application of talents, and strengths makes a letter of reference highly specific.

Curriculum Design: 1) Talents: Take the Strengthfinders test in order to find out the resident’s top five talents. For example, the resident used his talent of ideation (his fascination by ideas) to develop a presentation relating his clinical experience to the anatomy laboratory. 2)

Talents in Action: Identify incidents in which the resident applied each of his talents. For example, the resident used his futuristic talent to plan for a conference presentation. 3) Talent Relationships: Evaluate the connections between striving talents (the why of a person), thinking talents (the how of a person), and relating talents (the who of a person) for this individual. 4) Strengths: Have the resident identify an activity that made him feel invigorated. For example, the resident was “glowing” when he helped an attending who had not performed blocks in a while to block an upper extremity while on call. 5) Competence and Talents: Break down the strengths to shows this resident’s particular competence (experiential knowledge and skills) and his talents that made this strength evident.

Outcome: The resident will know what information to supply to get a highly specific letter of reference. He will identify his talents and strengths.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Required Research Rotation for CA-1 Residents

Harriet W Hopf 1, Kathleen C Light 1, Nathan L Pace 1, L Lazarre Ogden 1, Michael K Cahalan 1

Learner Audience: CA-1 Anesthesiology Residents at the University of Utah

Background: Problem based learning and improvement is a core competency of residency training. The Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Graduate Medical Education in Anesthesiology (July, 2008) include: “The curriculum must advance residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care” and “Residents should participate in scholarly activity.”

Needs Assessment: Most current anesthesiology training programs provide optional research time late in residency. This delays developing a competency in problem based learning and limits resident interest in pursuing a career in research.

Hypothesis: We propose that research experience early in residency will increase resident competence in problem-based learning, increase the role of basic scientists in resident education, and may increase resident interest in a career in academic medicine.

Curriculum Design: CA-1 residents meet with the rotation directors in July to identify areas of interest. Residents then interview four potential mentors, including two basic scientists. Resident projects range from reviewing pertinent literature to participating in ongoing research or pursuing a limited project of their own. During the four-week rotation, residents pursue a formal statistical curriculum in addition to research experience. Formal presentations are required. Submission of abstracts is encouraged.

Outcome: The first resident began his rotation in January 2009. Residents and basic science faculty found the interview phase rewarding. Resident projects include a bench project, participation in data collection for an ongoing clinical study, writing a review article, creating a patient education video and evaluating its effectiveness, and analyzing data from a previously completed study. The impact of the rotation will be evaluated by the quality of written and oral presentations, surveys of residents and mentors, changes in evaluation of problem-based learning competency for CA-2 and CA-3 residents, and entrance of residents into further research training.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Follow-up Study: A Focused Anesthesia Training Month in the PGY-1 Year Does Not Impact AKT scores

E Dabbs Loomis 1, Kenneth Oswalt 1, Claude Brunson 1

Learner Audience: Anesthesia training programs

Background: Recently, the department of anesthesia incorporated a focused anesthesia training month at the end of the PGY-1 year. Previous studies demonstrated that this month benefited residents in two ways. First, it provided residents with the appropriate training to allow them to work independently from July 1. Secondly, the previous study suggested that residents who rotated through a focused anesthesia training month had increased AKT-1 scores at the beginning of their CA-1 year. This led us to conclude that the introductory course gave residents an increased knowledge base at the beginning of their training.

Needs Assessment: To better train residents and equip them with the skills necessary to begin their CA-1 year, UMMC has instituted a uniform anesthesia training month during the PGY-1 year.

Hypothesis: We hypothesize that incorporating a focused anesthesia training month at the end of the PGY-1 year will increase AKT scores by giving residents a more solid foundation on which to begin their CA-1 training.

Curriculum Design: To objectively evaluate the PGY-1 focused training month, we compared AKT T-scores between residents who did not participate in a focused introduction to anesthesia (Class of 2009) with those that did (Class of 2010 and 2011).

Outcome: Residents who participate in a focused anesthesia training month do not appear to perform better on their AKT than those that do not. These data refute our hypothesis that the introductory course gives residents an increased knowledge base in the beginning of their training. Despite this, the month does enable residents to work independently from July 1 of their CA-1 year, thereby increasing productivity in the OR.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

How to Submit a Research Application to the USC IRB for a Novice Applicant

Jennifer Noerenberg 1, Diane McIntee 1, Philip Lumb 1

Learner Audience: medical students/residents

Background: Anecdotally, it has been shown that students and residents have struggled to navigate the IRB application process due to the vast amount of paper work and the poor organization and guidance from the institution to support the novice.

Needs Assessment: In order to stimulate change, a new document needs to be drafted to promote ease of use.

Hypothesis: Based on previous attempts at organizing the information and the 400 page complete body of policies and procedures, an approximately 10 page document entailing the most important details with appendices of templates and instructions compiling the necessary pieces of the application will improve success.

Curriculum Design: It will touch on the basics of human research subjects, cover tips and recommendations for writing a sound, feasible protocol, ancillary study documents and application. It also provides information regarding IRB study review types, investigator roles and possible outcomes. Finally the document compiles instructions and templates of protocol, study documents and applications in a list of appendices. The specific templates include a protocol template, instructions and screen shots of the online application entry site, informed consent instructions and template, patient bill of rights instruction and template, HIPAA disclosure instructions and template, and samples of a drug inventory form, laboratory agreement, budget, study staff instruction, timeline flowchart, and data collection form.

Outcome: Has yet to be assessed, as the document is in the final drafting stages with the cooperation of the USC IRB. In the coming months, an examination of approval rates and document usage will be assessed.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Can You Intubate? A Continuous Statistical Analysis of Clinical Competence

LM Pott 1, AO Budde 1, S Vaida 1, V Reddy 1

Learner Audience: All anesthesiology residents, throughout their training. Study has IRB approval.

Background: Anesthesiology residents must become competent at intubation using a variety of different techniques, and the training institution should document that competence. Statistical process control, particularly the CUSUM technique, determines whether the resident’s performance is superior to a predetermined rate, and displays the performance curve graphically. This technique has been applied to assess technical proficiency in medical practice previously (see appendix 1).

Needs Assessment: The ABA and the ACGME requires documentation of clinical competence. Our Department, like many others, had no record of resident performance at intubation. Merely counting cases provides no information about whether the attending or the resident performed the task, or whether success was achieved. Oversight of airway training was lacking.

Hypothesis: The intervention goal was to continuously monitor resident performance, thereby identifying suboptimal practice enabling corrective action. Group data can be used to determine the average number of cases required for establishing competence at a skill, providing a scientific basis for training requirements.

Curriculum Design: Residents use a check-list (fig 1) to record performance for every case. The data is entered into a spreadsheet for each resident and graphs determined (fig 2 and 3). Practice Based Learning is promoted strongly by reviewing the data with the resident. Statistical techniques can be used to determine the probability that the next attempt will be successful. The described technique can be used to assess training program performance.

Figure 1.

Figure 1

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Airway Audit Form

Figure 2.

Figure 2

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Graphical representation of success / failure at intubation. (Successes are plotted

Figure 3.

Figure 3

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Cummulative Sum (CUSUM) graph. (Note that successes are plotted downward).

Outcome: The analysis allows early feedback for under-performing residents, and forms an objective basis for the rapid promotion of high-achievers. The CUSUM provides accurate data on learning curves. This analysis provides medico-legal protection for the individual and the training institution by documenting skill level and adequacy of training. The technique is likely to be suitable for assessing all motor skills (regional anesthesia, invasive monitoring) and can easily be introduced at other institutions. Provided the same performance criteria are used, multi-center data collection is easy.

Appendix 1 References:

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

How to Improve Knowledge in Transfusion Medicine-The Development of a Blood Bank Rotation for Anesthesiology Residents in the Clinical Base Year

Annette Rebel 1, Zaki-Udin Hassan 1, Elpidio Pena 1, Randall M Schell 1, Amy Dilorenzo 1

Learner Audience: Anesthesiology Faculty and Residents

Background: knowledge of blood products and utilization is expected from anesthesiologists. The perioperative use of blood products is necessary to manage blood loss and/or coagulopathy during surgery. Unnecessary use of blood products is expensive; and can pose significant risks patients. The American Board of Anesthesiology In-Training Exam (ABA-IT) results from 2005-2007 show anesthesia residents at an early training level answered < 60% of the Hematologic -Organ Based Clinical questions correctly. Advanced anesthesia residents (CA-3) still demonstrated significant knowledge gaps with only 70% correctly answered questions.

Needs Assessment: To improve the knowledge of anesthesia residents at our institution, we have developed a rotation in Transfusion Medicine in the Clinical Base Year in cooperation with the Department of Pathology.

Hypothesis: We hypothesize that training residents in the clinical base year in the practice of hematological medicine will significantly increase their knowledge and effective use of blood and blood products

Curriculum Design: Rotation: clinical base year one month

  1. perform important blood tests in the laboratory under guidance and supervision including PT/PTT/Thromboelastogram [TEG]/ABO-testing/Cross-match;

  2. follow blood from donation to end product by spending 1-2 days at the Central Kentucky Blood Donation Center;

  3. learn about blood storage procedures in the blood bank;

  4. obtain clinical experience concerning management hematological disorders and anticoagulation management by attending Hematology Clinics Cell and pathology lecture schedules

  5. Review current literature in transfusion medicine.

Outcome: To determine the knowledge level before the rotation, every resident undergoes a pre-test with 50 multiple choice questions about hematological topics. At the end of the rotation the resident will be tested with a written exam containing 50 multiple choice questions (post-test) and a mock oral board exam with a transfusion medicine related topic. In addition, each resident submits written descriptions of 2-4 transfusion related keywords. The sum of these components will be considered for the final resident evaluation.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Anesthesiology Residents as Teachers: Curriculum Development for a Resident Teaching Elective

Danielle Roussel 1, Harriet W Hopf 1, Michael K Cahalan 1, Lazarre L Ogden 1

Learner Audience: Anesthesiology Residents

Background: Teaching skills development is an important component of residency training. The AAMC recommends implementing structured resident curriculum for developing residents as teachers. The ACGME expects that residents “develop skills and habits to be able to participate in the education of patients, families, students, residents and other health professionals.”

Needs Assessment: Most anesthesiology residents have had little or no formal training in medical education; their teaching skills have been acquired primarily through an informal curriculum of observation and practice. Prior to the introduction of the Resident Teaching Elective our anesthesiology department did not have a curriculum for developing residents as teachers.

Hypothesis: Anesthesiology residents serve an integral role in the clinical anesthesiology education of rotating medical students; residents who choose to pursue a career in academic anesthesiology will continue to rely on their teaching skills as they participate in medical student and resident education. The development of a formal Resident Teaching Elective curriculum will improve resident teaching.

Curriculum Design: The Resident Teaching Elective is offered to senior anesthesiology residents during four-week rotations in the University Operating Rooms. The curriculum emphasizes five categories of medical education: characteristics of effective teachers, learning and education theory, curriculum development, teaching skills for different learning environments, and feedback and evaluation. Learning modalities are directed reading, faculty mentorship, and practical experience. Practical teaching experiences with rotating medical students include providing one-on-one clinical teaching in the perioperative setting, developing and delivering OR teaching topics, facilitating skills development workshops in our patient simulator, and preparing a one-hour didactic conference.

Outcome: Faculty observation suggests that the curriculum has favorably affected resident teaching. Feedback from faculty mentors, resident participants, and medical students has been positive. Improvement strategies for the elective include increasing faculty mentoring, compiling resident deliverables, and minimizing logistic challenges. We are formulating an evaluation plan to objectively measure the impact of the Resident Teaching Elective.

References:

Whitcomb, W. The Clinical Education of Medical Students: Report on Millennium Conferences I & II. in Millenium Conferences I & II. 2001, 2002.

http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Simulator-based Elective Course for Medical Students: An Innovative, Simulator-Based Anesthesia Curriculum Designed for Medical Students by Medical Students

Mark Scheible 1, Teresa Hoyt 1, Suzanne Karan 1

Learner Audience: Third and fourth year medical students

Background (previous data to support hypothesis): Simulator-based learning centers have proven effective for teaching and evaluating staff and students of health care, including medical students and anesthesiology residents.1 Despite national increase in these learning centers, data demonstrate underutilization.1,2 A decrease in patient-based training opportunities for all health care providers highlights the need to further develop simulator-based learning experiences.3

Needs Assessment (justification for change): Anesthetic principles of cardiopulmonary management are rarely unified into clinical medical school learning objectives. Medical students are largely exposed to anesthesiology as passive observers, due to patient safety concerns, residents’ and attendings’ varied ability to teach, and time constraints. This passive approach can discourage career interest in the field, as well as delay assimilation of learning objectives critical for clinicians of every specialty.

Hypothesis (justification for intervention and projected outcome): This course provides the medical student with opportunity to integrate basic science and clinical knowledge, develop team communication, and improve decision-making and procedural skills in a safe environment. These active experiences may facilitate interest in the field of anesthesiology, as well as provide an opportunity for prospective data on the effectiveness of simulator-based learning centers for teaching medical students.

Curriculum Design (methods, learner evaluation, if applicable link to ACGME competency): This five day elective course, limited to two to four students, utilizes the Meti HPS simulation suite. Each of the first four days is dedicated to a group of learning objectives: essential pharmacology, cardiopulmonary physiology and pathophysiology, and skills such as intubation and set-up of an anesthesia machine. The final day integrates all of the course objectives with a series of complex scenarios. Student evaluation is based on participation; grading is pass/fail.

Outcome (curriculum assessment, future improvements, feasibility, reproducibility): Feasibility and effectiveness in achieving learning objectives will be assessed by pre- and post-course surveys completed by students. Data collection will conform to APS/NIH Guidelines and results published with the approval of the IRB.

Sources

  • 1.Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005; 27 (1): 10-28. [DOI] [PubMed] [Google Scholar]
  • 2.Morgan PJ, Cleave-Hogg D. A worldwide survey of the use of simulation in anesthesia. Can J Anaesth. 2002; 49 (7): 659-62. [DOI] [PubMed] [Google Scholar]
  • 3.Sanson-Fisher RW, Rolfe IE, Williams N. Competency based teaching: the need for a new approach to teaching clinical skills in the undergraduate medical education course. Med Teach. 2005; 27: 29-36. [DOI] [PubMed] [Google Scholar]
J Educ Perioper Med. 2009 Jul 1;11(2):E052.

The Use of Simulation in Resident Training to Demonstrate a Decrease in Negative Airway and Related Outcome Measures

Tracey Straker 1

Learner Audience: Anesthesia Residents and Anesthesia Attendings

Background: I co-authored an abstract that was presented at the ASA 2008 entitled Decreased Airway Complications after Introduction of an Airway Curriculum in an Academic Setting. This abstract demonstrated a decrease in case cancellation secondary to the introduction of an airway curriculum. I feel that the introduction of simulation into the airway curriculum can demonstrate a decrease in other outcomes measures as well. These outcomes measures include time to secure the airway, dental trauma, patient satisfaction (sore throat), and steroid use and surgical airway.

Needs Assessment: The justification for the change include data analysis from our electronic database that shows significant referrals to dental clinic for trauma incurred during intubations, the use of steroids and postoperative ventilation related to traumatic intubations, and perioperative myocardial infarction that may be linked to a traumatic intubation.

Hypothesis: The hypothesis to be tested is the inclusion of simulation into an already existing curriculum will further decrease negative airway outcomes and decrease related outcomes associated with airway management.

Curriculum Design: The CA3 residents are stratified into 2 groups by odd and even months of the academic year. The odd month group is trained with the existing curriculum and simulation while the even month group is trained with the existing curriculum without simulation. The two groups are reversed as described in a waitlist study so that all residents benefit from simulation education. The rotation is broken into clinical and theoretical components.

Outcome: The curriculum is assessed by resident written and oral exams as well as computerized simulation exercises. The change in competence and confidence is assessed by a scorecard given to the resident for pre and post rotation assessment. Improvements will disseminate throughout the department by resident and attending teaching. This model has a feasible structure and is easily reproducible for integration to our already existing airway curriculum.

I have expedited IRB approval and adherence to the APS/NIH guidelines.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

The Stanford ETHER Project: An Intranet Portal for Anesthesia Education and Research

Larry F Chu 1, Kyle Harrison 1, Alex Macario 1

Learner Audience: Internet-users, anesthesia residents/faculty

Background: Web-based resources are a growing area of technological innovation in anesthesia education. Despite its ubiquity, there is a dearth of highly-developed internet websites incorporating advanced features such as Web 2.0 technology, multimedia podcast content and support of anesthesia service work through integrated messaging platforms.

Hypothesis: Anesthesia residents will utilize high-value educational content and interactive internet features in an advanced Web 2.0 educational intranet portal.

Method Design: Between 2/29/08–3/4/08, we conducted a needs-assessment survey of residents in the Stanford Anesthesia residency program. Incorporating the design features and elements requested by residents we then constructed an internet portal site (http://ether.stanford.edu) to support anesthesia education. Finally, we examined web server logs of web site usage (7/1/2008–1/30/2009) to determine which web site features were actually being utilized. IRB approval wasn’t required as only anonymous web server logs were utilized.

Outcome: Web server activity logs show that Ether was accessed by 13,789 unique visits since it was launched on 7/1/2008, averaging 64 unique users per day. The mean duration for each visit was 6 minutes and 44 seconds. Page visit break down were (Figure 1): homepage (55%), paging services (24%), CA-1 tutorial (2.2%), social activity photos (2.06%), telephone directory (1.66%), and resident call schedule (1.37%). Interestingly, content domains of Ether that were the most labor-intensive to produce, including video podcast lectures, an interactive digital library of educational PDF literature and powerpoint lecture files, accounted for less than 1% of total web site traffic. A disparity exists between what residents say they want (multimedia and podcast lectures) and actual usage of web site features which mainly involved service-related functions such as online paging, telephone directory, and call schedule information. Future research will explore possible reasons for this behavior as well as methods for improving knowledge of available features among residents. Optimal interface and web site design to facilitate access to high-value educational content deserves further study.

Figure 1.

Figure 1

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Page views where 1=homepage, 2 and 3=paging services, 4=CA-1 tutorial, 6=Social photos, >7 are less than 2% of total page views

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Residents’ Epidural and Spinal Placement Time As a Marker for Proficiency: How Long on OB Is Long Enough?

*Elizabeth H Ellinas *, **Daniel C Eastwood *

Learner Audience: Anesthesiology Residents on OB Anesthesiology

Background: Investigators employing both learning curves1 2 and cusum3 analysis have estimated that residents must perform 60-90 epidurals and 45-70 spinals to become proficient. Most have had only “success” and “failure” as outcomes, and none have incorporated the relative difficulty of the case into their analyses.

Hypothesis: In our study of regional anesthetic difficulty, we considered resident experience as a potential predictor of difficulty. Examining that same data from a different angle, we now consider the residents separately, and ask, what can resident placement time tell us about how they learn?

Method Design: This study examined pregnant patients for risk factors predisposing them to neuraxial anesthetic difficulty. One marker for difficulty was the placement time from local-anesthetic skin infiltration to either spinal injection or epidural catheter threading. Three predictors were originally identified: two were patient characteristics, and the third was resident experience, defined as the number of days the resident had spent on OB Anesthesiology, where residents accrue 40-50 neuraxial procedures/month. This study delved into the resident-learning component of the results by developing a regression model specifically focused on the resident and staff placement times.

Outcome: When stratified for patient predictors for difficulty, the linear regression model of log time demonstrated that the placement time for a resident-initiated neuraxial anesthetic decreased linearly over 5 months of OB Anesthesia service, but did not reach attending levels of efficiency. The model also demonstrated that “difficult” cases required more time for all practitioners, regardless of experience.

For residents in our study, efficiency – and perhaps proficiency – increased over a time span much longer than the two months of OB Anesthesiology required by the ACGME. We did not see the rapid improvement followed by a plateau that can be more typical of learning curves. At some point, the resident placement time must plateau and approach the attendings’ time, but that point can’t be determined from our current data.

Graphs: Submitted as separate attachment.

Footnotes

1

Kopacz DJ. Reg Anesth 1996;21:182-90.

2

Konrad C. Anesth Analg 1998;86:635-9.

3

Naik VN. Can J Anesth 2003;50:694-8.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Anesthesiology Resident and Attending Perceptions of Written Evaluation Comments

Kevin W Hatton 1, Amy DiLorenzo 1, Maria Melguizo-Castro 1, Randall M Schell 1

Learner Audience: Anesthesiology Residency Program affiliated with University Hospital

Background: Anesthesiology residents are routinely evaluated using a variety of evaluation methods including written examination, oral examination, and written focal faculty evaluations. Written focal faculty evaluations typically have specific sections where unsolicited written comments to residents can be provided.

Hypothesis: This study was designed to determine whether there was a difference in the perception of these comments (in terms of being either positive or negative) between anesthesiology residents and attending faculty staff.

Method Design: All anesthesiology residents and attending faculty in the Department of Anesthesiology at the University of Kentucky were asked to assess their perception of 50 randomly-selected statements from previously-submitted daily focal faculty evaluations of residents from 07/2008-12/2008 using an anonymous internet-based survey. These statements were evaluated on an ordinal scale from “extremely negative (-10)” to “extremely positive (+10)”. The mean perception rating of each comment was then compared between the groups. Institutional review board approval was obtained post-hoc to present data.

Outcome: Twenty-seven faculty members (60%) and 29 residents (63%) completed the survey. The data from 2 faculty and 3 residents were excluded from analysis. There were no statistical differences in the mean perception ratings between the two groups in the majority of the statements (N=40 (80%)). Of the 10 comments with a statistical difference between the mean perception ratings, residents perceived the positive comments (N=6) to be more positive than did the faculty and the negative comments (N=4) to be more negative than did the faculty. (Figure 1) This data supports the continued use of free-form faculty evaluation of residents to communicate their overall impression of the residents’ performance. This data should, however, be repeated in a larger, multi-institutional study to more-fully evaluate the differences in comment perceptions between residents and faculty.

Figure 1.

Figure 1

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Differences in mean perception rating between faculty and resident responses. (MPR = Mean Perception Rating, SD = Standard Deviation)

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Invitational Rhetoric as a Tool for Surgeon / Anesthesiologist Communication

Kris Kirschbaum 1, Sally Fortner

Learner Audience: This research is aimed toward other researchers, including, but not limited to anesthesiologists who are interested in education and communication.

Background: Mis-communication occurs frequently in the stressful, hectic operating room (OR) environment. Adverse events follow mis-communication more frequently than provider incompetency. Communication concerns prompted the ACGME to institute competency requirements to address communication issues at the trainee level. However, an empirical approach to understanding what factors contribute to mis-communication among healthcare providers is not yet substantiated. The primary aim of the present study is to examine and measure factors that contribute to miscommunication in the OR. Given that the OR is a unique culture, this study includes factors consistently measured in intercultural communication research: 1.) autonomous versus group affiliation (self-construal); 2.) interaction strategies (face concerns), and; 3.) conflict-management style. These factors are measured using survey data collected for anesthesiologists and surgeons (attending and resident level). The data provide greater knowledge of what differences exist that may contribute to mis-communication between OR providers. Knowledge of these differences improves the ability to design effective and appropriate communication training for anesthesiologists and surgeons to reduce mis-communication.

Hypothesis: Variance exist in factors of self-construal, face concerns, and conflict management style between anesthesiologists and surgeons (attending and resident). The variance may contribute to mis-communication and may be reduced through effective communication training design.

Method Design: Data were collected through survey items that measure factors in anesthesiologists and surgeons—attending and resident—and statistically analyzed using factor analysis, correlation matrices, t-tests, and structural modeling techniques. UNM IRB (FWA 00004690) proposal # 28075, approved 4/25/2008.

Outcome: The data established differences between attending and resident for the measured factors. Additionally there was lack of evidence to support group affiliation in either specialty. These results suggest communication training needs to address inherent autonomy in the specialties and variation among training levels. Future research includes increasing study strength through participation of additional institutions.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Have Personal Statements Become Impersonal? An Evaluation of Personal Statements in Anesthesiology Residency Applications

Bryan Max 1, Brian Gelfand 1, Meredith Brooks 1, Rena Beckerly 1, Scott Segal 1

Learner Audience: Academic anesthesiology training programs

Background: The electronic residency application service (ERAS) is used by anesthesiology residency programs to help facilitate applicant selection. In addition to objective data, applicants are required to submit a personal statement as part of their ERAS application. The subjective nature of the statement makes it a unique and valuable tool in an effort to help identify those to be selected for an invitation to interview. Anecdotally, the personal statement has been used to help differentiate between applicants who have similar academic records. However, readers at our institution have found an increasing number of essays each year that tend to share common features. No study has systematically evaluated the content of these statements.

Hypothesis: Analysis of content of personal statements would demonstrate frequent discussion of common themes and a general lack of originality. The Program Directors reading these statements would not find them particularly useful during the resident selection process.

Method Design: The prevalence of 13 specific essay features and eight quality ratings was calculated for the essays and correlated with other aspects of the residency application abstracted from the Electronic Residency Application Service (ERAS) files for all 2006 applicants to BWH. Six question survey regarding use of personal statements was collected from program directors. A total of 670 essays were evaluated.

Outcome: Interest in physiology and pharmacology, enjoyment of a hands-on specialty, and desire to comfort anxious patients were each mentioned in more than half of the essays. However, the overall rating of “original” was strongly positively correlated with the number of commonly discussed features. Higher quality ratings were also strongly associated with graduation from a U.S. or Canadian medical school, applicant file screening score, invitation for interview, female gender, and younger age. More than 90% of program directors found proper use of English to be a somewhat or very important feature of the essay. However, only 41% found the personal statement overall to be very or somewhat important in selecting candidates for interview invitations.

J Educ Perioper Med. 2009 Jul 1;11(2):E052.

Oral Examinations as a Tool to Evaluate the ACGME Competencies

Janine R Shapiro 1, Denham S Ward 1

Learner Audience: Medical Educators, Residents

Background: The ACGME requires training programs to educate residents in six general core competencies and to provide methods of assessing residents’ attainment of these competencies. The oral examination (OE) is a type of performance assessment using realistic patient scenarios and is a useful tool for resident education, the assessment of resident performance, and to provide resident familiarity with the ABA oral examination (ABA-OE).

Hypothesis: To determine faculty and resident opinions as to the ability of the ABA-OE model to be used to evaluate all six ACGME competencies including the newer domains of practice-based learning, systems-based practice, and professionalism.

Method Design: Thirty faculty examiners and 45 examinees participated in our routine mock oral examination process. Five different guided examinations were used. At the end of each examination, examiners and residents were asked to complete a survey and rate whether the ABA-OE provided information to evaluate the resident performance within each of the six ACGME competencies. Surveys were de-identified and analyzed using Student’s t-test and ANOVA.

Outcome: Eighty-eight examiner surveys (99%) and 41 examinee surveys (91%) were returned. Examiners rated the ABA-OE format significantly better for the assessment of the competencies in patient care, knowledge, and interpersonal and communication skills as compared to the competencies in practice-based learning and improvement, professionalism, and systems-based practice (p < 0.05) (Table 1). There were no significant differences in ratings between examiners and examinees with the exception of the competencies in medical knowledge, which was rated higher by the faculty, and professionalism, which was rated higher by the examinees.

Table 1.

ABA-OE Survey Result

Patient Care Knowledge Practice-Based Learning Interpersonal & Communication Skills Professionalism System-Based Practice
Faculty Examiner 3.0 ± 0.9 3.5 ± 0.7 2.6 ± 1.0 3.2 ± 1.1 2.3 ± 1.2 2.3 ± 1.1
Examinee 2.8 ± 1.1 3.3 ± 0.8* 2.7 ± 1.1 3.1 ± 1.1 2.7 ± 1.3* 2.5 ± 1.1
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*

p < 0.05 vs. faculty examiner

Our results indicate that the ABA model may be a better tool for the assessment of the ACGME competencies in patient care, medical knowledge, and interpersonal and communication skills, compared to the newer domains of practice-based learning and improvement, systems-based practice, and professionalism. Future work will include modification of the ABA-OE format to improve assessment of the newer domains.

Appendix A Oral Examinations and ACGME Competencies Survey

Please rate whether Oral Examination provided information (Level of Inference) to evaluate the resident performance within each of the six ACGME competencies (irrespective of the resident’s actual performance)

ACGME Competencies Definition Level of Inference
None Some Definite
Patient Care Ability to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health 0 1 2 3 4
Medical Knowledge Demonstration of knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care 0 1 2 3 4
Practice-Based Learning and Improvemen Ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning 0 1 2 3 4
Interpersonal and Communication Skills Demonstration of interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals 0 1 2 3 4
Professionalism Demonstration of a commitment to carrying out professional responsibilities and an adherence to ethical principles 0 1 2 3 4
System-Based Practice Demonstration of an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care 0 1 2 3 4
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Articles from The Journal of Education in Perioperative Medicine : JEPM are provided here courtesy of Society for Education in Anesthesia

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