Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum.
A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1) were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II) in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software.
Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49) and 16.6% (CI 0-0.34) respectively. After the additional training program in the operating room the success rates increased to 83.3% (CI 0.66-1) and 88.8% (CI 0.73-1), respectively. The differences in success rates were statistically significant (P = 0.002 and P = 0.0004, respectively).
The success rate of emergency medicine residents in airway management improved significantly after completing anesthesiology rotation. Anesthesiology rotations should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.
Education; Curriculum; Anesthesiology; Emergency Medicine
The role of residents as teachers has grown over time. Programs have been established within various specialties to formally develop these skills. Anesthesiology residents are frequently asked to provide supervision for novice learners and have numerous opportunities for teaching skills and clinical decision making. Yet, there are no educational programs described in the literature to train anesthesiology residents to teach novice learners.
To explore whether a resident-as-teacher program would increase anesthesiology residents' self-reported teaching skills.
An 8-session interactive Anesthesiology Residents-as-Teachers (ART) Program was developed to emphasize 6 key teaching skills. During a 2-year period, 14 anesthesiology residents attended the ART program. The primary outcome measure was resident self-assessment of their teaching skills across 14 teaching domains, before and 6 months after the ART program. Residents also evaluated the workshops for quality with a 9-item, postworkshop survey. Paired t testing was used for analysis.
Resident self-assessment led to a mean increase in teaching skills of 1.04 in a 5-point Likert scale (P < .001). Residents reported the greatest improvement in writing/using teaching objectives (+1.29, P < .001), teaching at the bedside (+1.57, P = .002), and leading case discussions (+1.64, P = .001). Residents rated the workshops 4.2 out of 5 (3.9–4.7).
Residents rated their teaching skills as significantly improved in 13 of 14 teaching domains after participation in the ART program. The educational program required few resources and was rated highly by residents.
The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center.
Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1 year later.
Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P < .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases.
Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.
The Accreditation Council for Graduate Medical Education (ACGME) requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships.
A variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card."
Metrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA) certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations), accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP) results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process.
An annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.
Education and training in advanced airway management as part of an anesthesiology residency program is necessary to help residents attain the status of expert in difficult airway management. The Accreditation Council for Graduate Medical Education (ACGME) emphasizes that residents in anesthesiology must obtain significant experience with a broad spectrum of airway management techniques. However, there is no specific number required as a minimum clinical experience that should be obtained in order to ensure competency. We have developed a curriculum for a new Advanced Airway Techniques rotation. This rotation is supplemented with a hands-on Difficult Airway Workshop. We describe here this comprehensive advanced airway management educational program at our institution. Future studies will focus on determining if education in advanced airway management results in a decrease in airway related morbidity and mortality and overall better patients' outcome during difficult airway management.
The admissions process for residency encompasses numerous objective and subjective measurements by which an applicant is evaluated. The personal interview and clinical evaluations are widely considered the most reliable method to identify unwanted behavioral characteristics. However, the role of a personal statement is less clear. There are reports of residency programs attempting to identify selfish or egocentric behavioral traits by counting the frequency of the first-person pronoun “I” in personal statements. The purpose of this study is to define the relationship between anesthesiology resident evaluations and the frequency of the first-person pronoun within their personal statements.
Resident evaluations of 48 anesthesiology graduates were collected for 5 competencies. The iScore was calculated by determining the frequency of “I” in relation to total word count.
Correlation analysis between iScore and the 5 evaluation categories showed no significant relationship.
When examining the relationship between resident evaluations and iScore, the lack of significant correlation makes it difficult to predict resident performance based on “I” counts. This may be because the personal statement is a thoughtfully developed document that undergoes extensive editing, which may suppress or minimize writing styles that suggest the presence of unwanted behavioral traits. Further examination of personal statements with a larger sample size and data from other institutions and specialties are needed.
The Ochsner Clinic Foundation Anesthesiology Residency Program is the oldest continuously accredited anesthesiology residency program in the state of Louisiana. As the American College of Graduate Medical Education has developed residency training requirements, so has the Ochsner training program evolved from a structure- and process-based program to an outcomes-based program. The author, associated with the program since 1983, reviewed Program Information Forms from 1971 to the present to track the evolution of the anesthesiology residency training program. The Accreditation Council of Graduate Medical Education demanded allocation of resources to residency training and mandated the demonstration of outcomes of training. The Ochsner Clinic Foundation Anesthesiology Residency Program has kept pace with these demands. The trend for graduate performance on written examinations has been upward. Fifty years ago, graduates practiced locally, but graduates now practice throughout the United States. Many completed fellowship training at increasingly higher profile institutions.
Anesthesiology; medical education; residency education
Current methods of selecting future residents for anesthesiology training programs do not adequately distinguish those who will succeed from the pool of seemingly well-qualified applicants. Some residents, despite high exam scores, may struggle in the OR in stressful situations.
This study examined whether specific neuropsychological and personality measures can distinguish high competency residents from low competency residents to aid in resident selection.
25 residents enrolled in an anesthesiology program at a major academic institution were identified for participation. 13 were evaluated identified as “high competency” residents and 12 as “low competency ” by the department's clinical competency committee. Groups were evaluated on measures of fine motor dexterity, executive functioning, processing speed, attention, and personality using IPIP-NEO.
There were no significant differences between groups on measures of fine-motor dexterity, executive functioning, processing speed, or attention. High competency residents scored significantly higher than low competency residents on measures of cooperation, self-efficacy, and adventurousness, and lower on measures of neuroticism, anxiety, anger, and vulnerability.
Although measures of fine-motor dexterity, executive functioning, processing speed, and attention do not appear to distinguish between high- and low competency residents in anesthesiology, specific personality characteristics may be associated with future success in an anesthesiology training program.
Background: Germany, like many other countries, will soon have a shortage of qualified doctors. One reason for the dissatisfaction amongst medical residents are the relatively unstructured residency training programs despite increasing importance of outcome-based education. The aim of our study was to identify characteristics and requirements for good teaching during anesthesiology residency training from the resident’s point of view.
Methods: A consensus workshop with residents from all medical universities in Germany was held. Participants were allocated to one of the three topics, chosen based on a 2009 nationwide evaluation of residency. The three topics were (A) characteristics of helpful/good teachers, (B) characteristics of helpful/good conditions and (C) characteristics of helpful/good curricular structure. Each group followed a nominal group technique consensus process to define and rank characteristics for a good residency.
Results: 31 (79.5%) resident representatives were present. The consented results put emphasis on the importance of structured curricula including transparent goals and objectives, in training formative assessments and quality assurance measures for the program. Residents further long for trained trainers with formal teaching qualifications and protected teaching time.
Conclusions: Good residency training requires careful consideration of all stakeholders’ needs. Results reflect and extend previous findings and are at least to some degree easily implemented. These findings are an important step to establish a broader consensus within the discipline.
residents; curriculum development; needs assessment; anesthesiology; consensus
Journal clubs are an integral element of residency training. We report the successful implementation of a monthly structured journal club in our anesthesia residency program. Based on resident surveys before and one year after its start, the journal club led to a significantly higher confidence in how to critically appraise literature and present a manuscript. The journal club also improved the residents' ability to search the literature and their statistical knowledge, skills that are essential in the practice of evidence-based medicine. We describe key features that may aid other training programs in organizing a stimulating an educational and sustainable journal club.
To implement a 360-degree resident evaluation instrument on the postanesthesia care unit (PACU) rotation and to determine the reliability, feasibility, and validity of this tool for assessing residents' professionalism and interpersonal and communication skills.
Thirteen areas of evaluation were selected to assess the professionalism and interpersonal and communication skills of residents during their PACU rotation. Each area was measured on a 9-point Likert scale (1, unsatisfactory performance, to 9, outstanding performance). Rating forms were distributed to raters after the completion of the PACU rotation. Raters included PACU nurses, secretarial staff, nurse aides, and medical technicians. Residents were aware of the 360-degree assessment and participated voluntarily. The multiple raters' evaluations were then compared with those of the traditional faculty. Intraclass correlation coefficients were calculated to measure the reliability of ratings within each category of raters by the Pearson correlation coefficient.
Four hundred twenty-nine rating forms were returned during the study period. Fifteen residents were evaluated. The response rate was 88%. Residents were ranked highest on availability and lowest on management skill. The average rating across all areas was high (8.23). The average mean rating across all items from PACU nurses was higher (8.34) than from secretarial staff (7.99, P > .08). The highest ranked resident ranked high with all raters and the lowest ranked was low with most raters. The intraclass coefficients of correlations were 0.8719, 0.7860, 0.8268, and 0.8575.
This type of resident assessment tool may be useful for PACU rotations. It appears to correlate with traditional faculty ratings, is feasible to use, and provides formative feedback to residents regarding their professionalism and interpersonal and communication skills.
The transition from internship to residency training may be a stressful time for interns, particularly if it involves a change among programs or institutions after completing a preliminary year.
We explored whether an e-learning curriculum would increase interns' preparedness for the transition to the first year of clinical anesthesiology training and reduce stress by improving confidence and perceived competence in performing professional responsibilities.
We tested a 10-month e-learning program, Successful Transition to Anesthesia Residency Training (START), as a longitudinal intervention to increase interns' self-perceived preparedness to begin anesthesiology residency training in a prospective, observational study and assessed acceptance and sustainability. After a needs assessment, we administered the START modules to 22 interns, once a month, using an integrated learning management and lecture-capture system. We surveyed interns' self-assessed preparedness to begin anesthesiology residency before and after completing the START modules. Interns from the prior year's class, who did not participate in the online curriculum, served as controls.
After participation in the START intervention, self-assessed preparedness to begin residency improved by 72% (P = .02). Interns also felt more connected to, and had improved positive feelings toward, their new residency program and institution.
Participation in our novel 10-month e-learning curriculum and virtual mentorship program improved interns' impression of their residency program and significantly increased interns' subjective assessment of their preparedness to begin anesthesiology residency. This e-learning concept could be more broadly applied and useful to other residency programs.
Hurricanes Katrina and Rita impacted a large portion of the medical community in Louisiana. We attempt to determine their impact on the anesthesiology workforce in Louisiana.
In May 2006, a survey was mailed to 368 Louisiana anesthesiologists, collecting demographic data, retirement plans, impact of Hurricanes Katrina and Rita, position vacancies, practice conditions, and the general state of healthcare in their area. All 3 anesthesiology residency programs in the state were contacted regarding their recent graduates. The 2010 RAND survey of the anesthesiology workforce was reviewed with respect to findings relevant to the state and region.
One hundred seventy surveys were returned, yielding a 46.2% response rate. Among the respondents, 13.9% intended to retire within 5 years and another 24% in 5 to 10 years. Since 2005, 63.9% had seen an increase in their daily caseload, 46.9% saw an increase in work hours, and 36.8% stated that their practices were trying to hire new anesthesiologists and were having difficulty filling these positions. Since 2005, the number of anesthesiology residents in Louisiana had declined by almost 50%, and the number of graduates remaining to practice in Louisiana had decreased by 43% from 7 to 4 annually.
Our 2006 survey provided qualitative evidence for a shortage of anesthesiologists in the state of Louisiana after the natural disasters in 2005 that was likely to worsen as residency output plummeted, fewer residents stayed in the state, and projected retirement increased. The regional data from the RAND survey a year later confirmed the impressions from our survey, with an estimate of an anesthesiologist shortage as high as 39% of the workforce. State membership surveys may serve as accurate barometers in the wake of major environmental upheavals affecting regional anesthesiology workforce conditions.
Hurricane Katrina; Hurricane Rita; physician shortages; workforce management
Mentorship is perceived as important for academic department development. The purpose of this study was to survey physicians in an academic anesthesiology department before and after the initiation of a formal mentorship program to evaluate the impact of the program over a 1-year period.
The effectiveness of establishing a mentorship program to promote career advancement was prospectively and anonymously evaluated by 52 anesthesiologists in an academic, tertiary care facility with a large residency program (>130 residents). We asked these physicians to complete a questionnaire on mentorship 2 weeks prior to and 3 months and 12 months after the establishment of the mentorship program. We used data from 26 (50%) participants who completed all 3 surveys to evaluate the impact of the formal mentorship program.
Baseline survey results revealed that the majority of anesthesiologists (71%) in our academic, tertiary care facility believed that mentoring was important/very important, but only 46% indicated that mentoring had been an important/very important contribution in their careers. Overall, the respondents' ratings of mentorship importance over the 1-year period did not increase despite the establishment of a formal program.
We present the first known study that sequentially followed physician evaluations of mentorship importance after the establishment of a mentorship program within an academic anesthesiology department. Study participants considered allotted, structured time for the mentors and mentees to focus on mentorship activities as necessary to provide the best opportunity for program success according to the general informal consensus of the participants in the study.
Academic medicine; anesthesiology; mentorship
The educational potential of a computer-controlled patient simulator was tested by the University of Southern California School of Medicine. The results of the experiment suggest unequivocally that there is a twofold advantage to the use of such a simulator in training anesthesiology residents in the skill of endotracheal intubation: (a) residents achieve proficiency levels in a smaller number of elapsed days of training, thus effecting a saving of time in the training of personnel, and (b) residents achieve a proficiency level in a smaller number of trials in the operating room, thus posing significantly less threat to patient safety. The small number of subjects in the study and the large within-group variability were responsible for a lack of statistical significance in 4 of 6 of the analyses performed; however, all differences were substantial and in the hypothesized direction. Thus, despite the narrowly circumscribed tasks to be learned by the experimental subjects, the findings suggest that the use of simulation devices should be considered in planning for future education and training not only in medicine but in other health care professions as well.
Endotracheal intubation (ETI) is an essential skill that emergency medicine residents learn throughout their training.
To evaluate the effect of implementing a postgraduate year (PGY)-1 anesthesiology rotation on ETI success in the emergency department during PGY-2.
Residents in the study group completed a 4-week PGY-1 anesthesiology rotation. During the first 6 months of PGY-2, we compared ETI performance of the study group with a control group who did not experience a PGY-1 anesthesiology rotation. Data recorded included date, level of training, first- and second-attempt success, rescue devices used, major adverse events, and intubation scenario. A Pearson χ2 test was used to compare first-attempt success, overall success (≤2 attempts), and adverse events rates between the 2 groups.
Overall success rate for the study groups was 95.7% (111 of 116), compared with 94.5% (137 of 145) for the controls (P = 66). First-attempt success for the study group was 78.4% (91 of 116), compared with 83.4% (121 of 145) for the control group; this was not statistically significant (P = .30). Observed major and minor adverse events were similar: 19.0% for the study group (22 of 116) versus 24.8% (36 of 145) for the control group (P = .26).
The addition of an anesthesiology rotation to the PGY-1 curriculum did not have a significant effect on ETI success or the rate of adverse events during the first 6 months of PGY-2. First-attempt overall success and adverse events of our PGY-2 study group were consistent with previously published studies.
Several authors have told the John Adriani story, but his proper recognition in developing the specialty of anesthesiology and his place as a pioneer have never been presented as such. The following article outlines his training and experiences in the early days of anesthesiology. The story of the many problems he encountered and how he developed teaching programs that remain in existence today is one to be admired and appreciated. Much of the information is from personal conversations with Dr Adriani. During his tenure as the Director of Anesthesia at Charity Hospital, I was a surgical house officer in the early 1960s and returned as an anesthesiology trainee in the late 1970s. We became close personal friends. He gave me hundreds of his slides, and we had many discussions about the past and current state of the specialty of anesthesiology.
Anesthesiology; Charity Hospital; medical history
With various types of complex patients being treated in a mixed medical–surgical–trauma intensive care unit (ICU), we hypothesized that there should be no difference in patient mortality with respect to the core training of the intensivist.
We reviewed the cases of all patients admitted to a mixed medical–surgical–trauma ICU at a Canadian university teaching hospital in 2007. Patients were assigned to 1 of 2 treatment groups (internal medicine, surgery/anesthesiology) based on the treating intensivist’s training. Our primary outcome was to compare patient mortality in the ICU between the groups. We used generalized estimating equations to determine 10-day mortality after admission to the ICU. A multivariate Cox hazard model was used to determine statistical significance and 95% confidence intervals (CIs) for 11- to 60-day mortality in the ICU.
A total of 961 patients were admitted from January to December, 2007. We found no significant difference between the groups in 10-day mortality (odds ratio 0.73, 95% CI 0.46–1.18, p = 0.20) and 11- to 60-day mortality (hazard ratio 1.43, 95% CI 0.62–3.30, p = 0.40) after admission to the ICU.
In a large university trauma centre that operates a mixed medicine–surgical–trauma ICU, there was no significant difference in mortality between patients managed by intensivists with core training in internal medicine and those managed by intensivists with training in surgery/anesthesiology.
High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.
High-Fidelity Patient Simulation; Anesthesiology; Patient Simulation; Performance Assessment; Systemic Review; Test Theory
To better standardize the teaching of professionalism, the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education established competency-based training milestones for internal medicine residency programs. Accordingly, professionalism milestones served as the basis for a faculty development program centered on providing feedback to postgraduate year 1 residents (interns) on their own professionalism behaviors during preceptor-resident sessions in the internal medicine continuity clinic.
To determine the level of faculty (n=8) understanding and comfort in providing feedback, surveys listing 12-month professionalism milestones were distributed to core internal medicine teaching faculty. Current interns (n=10) also rated their understanding of the same milestones. The faculty development program included interpersonal communication education, role-plays of difficult situations, and pocket resources, as well as direct feedback on videotaped sessions with residents. At the end of the intervention period, participating faculty completed a postdevelopment survey, and the current 6-month interns completed a follow-up assessment.
Average ratings between the pre- and postintervention teaching faculty surveys fell approximately 0.25%-0.50% on all measures of understanding, but increased slightly on measures of comfort. Conversely, average ratings between the pre- and postintervention 6-month intern surveys generally increased 0.25%-0.50% for measures of comfort and understanding.
The faculty perceived the intervention as helpful in teaching them to focus on behaviors that change the context of overall feedback delivery. However, the study results showed that the system in place was not conducive to implementing such a program without modification and the introduction of resources.
Graduate medical education; quality improvement
Residency programs desire assessment tools for teaching and measuring resident attainment of the Accreditation Council for Graduate Medical Education competencies, including interpersonal and communication skills.
We sought to evaluate the use of emotional intelligence (EI) assessment and training tools in assessing and enhancing interpersonal and communication skills.
We used a quasi-experimental design, with an intervention and control group composed of 1 class each of family medicine residents. The intervention was EI coaching. The assessment used the Emotional and Social Competence Inventory, a 360-degree EI survey consisting of self and other (colleague) ratings for 12 EI competencies.
There were 21 participants in each of the 3 assessments (test, posttest, and control). Our EI coaching intervention had very limited participation due to a lack of protected time for EI coaching and residents' competing obligations. Return rates for self surveys were 86% to 91% and 66% to 68% for others. On all 3 trials, ratings by others were significantly higher than self ratings for every competence (range, P < .001–.045). None of the self ratings by the intervention group increased significantly for any of the competencies. None of the intervention group self ratings increased significantly on posttesting, whereas ratings by others increased significantly for coach/mentor (P < .001). The teamwork rating decreased significantly on both self and other ratings (P < .001). Achievement orientation was the highest intervention group posttest rating, and teamwork was the lowest.
EI is a necessary skill in today's health care environment, and our study found that a tool from another sector was useful in assessing resident EI skills. Because our EI coaching intervention was unsuccessful, the effects of coaching on interpersonal and communication skills could not be assessed.
We sought to create a resident educator program using a Train-the-Trainer (TTT) approach with adaptable curricula at a large tertiary health care center with a medical school and 60 accredited residency programs.
The Resident Educator And Life-long Learner (REALL) Program was designed as a 3-phase model. Phase 1 included centralized planning and development that led to the design of 7 teaching modules and evaluation tools for TTT and resident sessions. Phase 2 entailed the dissemination of the TTT modules (Learning Styles, Observational Skills, Giving Feedback, Communication Skills: The Angry Patient, Case-Based Teaching, Clinical Reasoning, Effective Presentations) to faculty trainers. In phase 3, specific modules were chosen and customized by the faculty trainers, and implemented for their residents. Evaluations from residents and faculty were collected throughout this process.
A total of 45 faculty trainers representing 27 residency programs participated in the TTT program, and 97% of trainers were confident in their ability to implement sessions for their residents. A total of 20 trainers from 11 residency programs implemented 33 modules to train 479 residents, and 97% of residents believed they would be able to apply the skills learned. Residents' comments revealed appreciation of discussion of their roles as teachers.
Use of an internal TTT program can be a strategy for dissemination of resident educator and life-long learner curricula in a large academic tertiary care center. The TTT model may be useful to other large academic centers.
The American Academy of Pain Medicine and the American Society for Regional Anesthesia have recently focused on the evolving practice of acute pain medicine. There is increasing recognition that the scope and practice of acute pain therapies must extend beyond the subacute pain phase to include pre-pain and pre-intervention risk stratification, resident and fellow education in regional anesthesia and multimodal analgesia, as well as a deeper understanding of the pathophysiologic mechanisms that are integral to the variability observed among individual responses to nociception. Acute pain medicine is also being established as a vital component of successful systems-level acute pain management programs, inpatient cost containment, and patient satisfaction scores. In this review, we discuss the evolution and practice of acute pain medicine and we aim to facilitate further discussion on the evolution and advancement of this field as a subspecialty of anesthesiology.
Teaching the next generation of physicians requires more than traditional teaching models. The Accreditation Council for Graduate Medical Education's Next Accreditation System places considerable emphasis on developing a learning environment that fosters resident education in quality improvement and patient safety. The goal of this project was to develop a comprehensive and sustainable faculty development program with a focus on teaching quality improvement and patient safety.
A multidisciplinary team representing all stakeholders in graduate medical education developed a validated survey to assess faculty and house officer baseline perceptions of their experience with faculty development opportunities, quality improvement tools and training, and resident participation in quality improvement and patient safety programs at our institution. We then developed a curriculum to address these 3 areas.
Our pilot survey revealed a need for a comprehensive program to teach faculty and residents the art of teaching. Two other areas of need are (1) regular resident participation in quality improvement and patient safety efforts and (2) effective tools for developing skills and habits to analyze practices using quality improvement methods.
Resident and faculty pairs in 17 Ochsner training programs developed and began quality improvement projects while completing the first learning module. Resident and faculty teams also have been working on the patient safety modules and incorporating aspects of patient safety into their individual work environments.
Our team's goal is to develop a sustainable and manageable faculty development program that includes modules addressing quality improvement and patient safety in accordance with Accreditation Council for Graduate Medical Education accreditation requirements.
Faculty development; graduate medical education; performance improvement; quality improvement
We have previously reported on our development and use of a minicomputer system for the Operating Rooms (OR) of Johns Hopkins Hospital [1,2]. This system schedules surgical procedures for the entire hospital. Consideration of the computing needs for the Department of Anesthesiology and Critical Care Medicine (DACCM) by a departmental task force identified areas where a local area network (LAN) could be of benefit. These included improvement in intradepartmental communication, increased computer availability, access to the OR scheduling system and to data bases maintained by other departments, and development of our own administrative databases. In 1989 a LAN was implemented in the DACCM and has achieved many of its goals. Impediments to acceptance of the LAN are: 1) human factors related to resistance to new “standards”, and 2) technical factors related to the inability of the LAN to precisely duplicate preexisting methods of handling information.