There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests... more There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity (LF) versus high-fidelity haptic simulation for epidural anesthesia. No study, however, has compared the effect of LF haptic simulation for epidural anesthesia versus mental imagery (MI) training in which no physical practice is attempted. We tested the hypothesis that MI training is superior to LF haptic simulation training for epidural anesthesia skill acquisition. Twenty Post-Graduate Year 2 (PGY-2) anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into 2 groups. Group LF had LF simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted MI training in which they initially were oriented to the epidural kit components and epi...
Journal of Cardiothoracic and Vascular Anesthesia, 2021
OBJECTIVE The use of basic transesophageal echocardiography (TEE) in critically ill and older sur... more OBJECTIVE The use of basic transesophageal echocardiography (TEE) in critically ill and older surgical patients can change patient management and improve outcomes after noncardiac surgery. The authors hypothesized that educating the future generation on basic TEE skills by an intense two-month rotation will help them achieve basic TEE certification by the National Board of Echocardiography (NBE) and facilitate good use of their skills for patient care during their practice. DESIGN This is a descriptive report of graduating anesthesiology residents who completed two months basic TEE rotation at the authors' residency program between 2013 and 2019. The authors report the clinical training goals, NBE testamur and certification status, and a survey report on the use of basic TEE skills in their practice SETTINGS: University medical center. PARTICIPANTS Residents who completed two months basic TEE rotation during their Clinical Anesthesia (CA)-3 year. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of a total of 115 residents, 67 (58%) elected basic TEE rotation. The NBE basic TEE certification and testamur status were achieved by 12 (21%) and 14 (24%) eligible residents, respectively. Residents (n = 43) personally performed 73 ± 21 (mean ± standard deviation) and reviewed 72 ± 28 (mean ± standard deviation basic TEE studies before graduation. The survey indicated that 63.4% of residents trained in basic TEE did not use their skills in their practice. CONCLUSIONS Two months' basic TEE rotation was able to fulfill its educational goals (testamur status and clinical training) but fell short on achieving NBE certification rate and its ultimate impact on practice and patient care.
STUDY OBJECTIVE Physician burnout is a pervasive problem in the United States. The goal of this s... more STUDY OBJECTIVE Physician burnout is a pervasive problem in the United States. The goal of this study was to investigate use of the smartphone meditation application Headspace® as a well-being improvement tool in anesthesia trainees. DESIGN Prospective self-controlled observational study. SETTING Anesthesia training program in an academic hospital. SUBJECTS Resident and fellow trainees in the Department of Anesthesiology and Perioperative Medicine at the University of Pittsburgh Medical Center. INTERVENTIONS Resident and fellow trainees were given a free 1-year subscription to the mindfulness application. Participation was voluntary and included questionnaires at baseline, 1 month, and 4 months for assessment of burnout and well-being. Questionnaires were linked with the use of de-identified codes and completed via REDCap. Questionnaires included the abbreviated Maslach Burnout Inventory, Becks Depression Index, Cohens Stress Score, Pittsburgh Sleep Quality Index, and a Headspace® Self-Reporting Questionnaire. MEASUREMENTS Depression, stress, sleep quality, emotional exhaustion, depersonalization, and personal achievement. MAIN RESULTS Of 112 trainees eligible to participate, 71 completed baseline questionnaires, 54 created application accounts, and 29 completed the entire questionnaire protocol with 4 months of app use. Application use was associated with reduced depression scores and increased feelings of personal achievement at both 1 month (p = 0.003, p = 0.066) and 4 months (p = 0.011, p = 0.005). Burnout from feelings of depersonalization and emotional exhaustion did not improve with application use. Over the study period, trainees completed 786 meditation sessions, accounting for 6123 min of app engagement. CONCLUSIONS Findings of decreased depression scores and improved feelings of personal achievement suggest that Headspace® could serve as a mindfulness tool for incorporating meditation into the daily practice of anesthesia trainees in an effort to improve well-being.
Journal of Education in Perioperative Medicine, 2019
Results: Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more... more Results: Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more faculty involvement in resident didactic after implementing the financial incentive. The quality of lectures also improved after the incentive switch, according to resident evaluations. There were higher overall Likert scores in AY 2018 and a higher percentage of positive responses to the question of whether presenters should return in AY 2017 and AY 2018, compared with AY 2016. Conclusions: After implementation of a financial incentive in place of nonclinical time, more faculty became involved in lectures and overall lecture quality improved as measured by resident evaluations.
Background – Patient education improves treatment plan compliance and outcomes. For anesthesiolog... more Background – Patient education improves treatment plan compliance and outcomes. For anesthesiology residents, patient communication is highlighted on the obstetric subspecialty rotation. However, the clinical effectiveness of patient education on patient-controlled epidural analgesia (PCEA) dose requirements is unknown. We hypothesized that patients receiving care by residents who are formally instructed on patient education for PCEA, will have lower total local anesthetic consumption and higher satisfaction. Methods – A prospective, interrupted time series design was chosen. Residents participated in one of two sessions at the beginning of their two-month obstetric anesthesia rotation: 1) Education (E): residents taught how to educate patients on PCEA, followed by instructor-resident practice implementing a “teach-back” method for patient comprehension; 2) Control (C): no formal instruction on PCEA. Confidence in patient education was assessed at baseline and at the rotation end. T...
STUDY OBJECTIVE Physician burnout and suicide are at epidemic proportions. There is very little d... more STUDY OBJECTIVE Physician burnout and suicide are at epidemic proportions. There is very little data directly comparing resident versus faculty well-being. The 2017-2018 ACGME resident and faculty surveys mark the first time that well-being questions were included. The purpose of this study was to determine whether responses to ACGME well-being questions would differ significantly between anesthesiology residents and academic anesthesiology faculty. DESIGN 2017-2018 ACGME well-being survey responses. SETTING All eight Pennsylvania anesthesiology residency programs. PATIENTS None. INTERVENTIONS None. MEASUREMENTS The authors compared the 5-point Likert scale responses (1 = Never through 5 = Very Often) between residents (371/384 responses, 97%) and faculty (277/297 responses, 93%) for each of the twelve well-being questions. Responses were also dichotomized as being ≥4 versus <4 for categorical comparisons. MAIN RESULTS Faculty responded higher than residents both by mean scores and percent of scores ≥ 4 for 6/12 questions (questions 1 (p < 0.001), 2 (p < 0.001), 4 (p < 0.001), 5 (p < 0.001), 8 (p < 0.001), and 11 (p = 0.001)). Residents responded categorically higher for question 9 (p = 0.022) although this was not considered statistically significant. Residents responded lowest for "Reflected on how your work helps make the world a better place" (question 1), whereas the lowest faculty responses were for questions 1, 9, and 10. Both had high responses for "Had an enjoyable interaction with a patient" (question 11). CONCLUSIONS Pennsylvania academic anesthesiology faculty survey responses demonstrated a higher level of well-being compared to their residents. The variation in scoring suggests that anesthesiology residents and faculty have differing perceptions of various well-being domains. Information from well-being surveys can help provide programs with focus areas that they can intervene on to improve physician well-being.
Academic medicine : journal of the Association of American Medical Colleges, Jan 7, 2016
The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Enviro... more The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Environment Review (CLER) program to evaluate and improve the learning environment in teaching hospitals. Hospitals receive a report after a CLER visit with observations about patient safety, among other domains, the accuracy of which is unknown. Thus, the authors set out to identify complementary measures of trainees' patient safety experience. In 2014, they administered the Hospital Survey on Patient Safety Culture to residents and fellows and general staff at 10 hospitals in an integrated health system. The survey measured perceptions of patient safety in 12 domains and incorporated two outcome measures (number of medical errors reported and overall patient safety). Domain scores were calculated and compared between trainees and staff. Of 1,426 trainees, 926 responded (65% response rate). Of 18,815 staff, 12,015 responded (64% response rate). Trainees and staff scored five domains simil...
The objective was to determine if there is a correlation between resident postgraduate year (PGY)... more The objective was to determine if there is a correlation between resident postgraduate year (PGY) of training and self-evaluation of performance using the Accreditation Council for Graduate Medical Education milestones. Survey. Residency program at a large academic center. Residents and Faculty Clinical Competency Committee (CCC). None. Resident and CCC milestone scores. Correlation coefficients for average score for each milestone vs PGY level ranged from 0.80 for receiving and giving feedback to 0.95 for anesthetic choice and conduct. All milestones showed a relatively linear relationship with PGY of training, and none were found to be consistently reached very late or very early in training. When examining variation across the scores for the individual residents, the distributions for PGY-2 and -3 appeared to be wider than those for PGY-1 and -4. The intraclass correlation coefficients ranged from 0.718 to 0.928. There was a remarkable degree of consistency in the relationship between level of training and resident self-assessment score for every milestone, as well as strong agreement between the resident and CCC faculty scores. Examination of the variance in the scores, when interpreted in light of our particular training program&amp;amp;amp;amp;amp;amp;amp;amp;#39;s characteristics, suggests that the milestones accurately reflect the progression in skill across the residency. In addition, given the concordance between the self-evaluation scores and the CCC faculty scores, self-evaluation may be a reasonable starting point as programs begin the daunting task of determining scores for each of the 25 milestones as part of the biannual evaluation process.
Do you need the book of A Case Approach to Perioperative Drug-Drug Interactions pdf with ISBN of ... more Do you need the book of A Case Approach to Perioperative Drug-Drug Interactions pdf with ISBN of 9781461474944? You will be glad to know that right now A Case Approach to Perioperative Drug-Drug Interactions pdf is available on our book collections. This A Case Approach to Perioperative Drug-Drug Interactions comes PDF and EPUB document format. If you want to get A Case Approach to Perioperative Drug-Drug Interactions pdf eBook copy, you can download the book copy here. The A Case Approach to Perioperative Drug-Drug Interactions we think have quite excellent writing style that make it easy to comprehend.
While narcotics remain the primary drug class for the treatment of perioperative pain, there is s... more While narcotics remain the primary drug class for the treatment of perioperative pain, there is strong interest in utilizing alternative analgesics with the goal of reducing narcotic-related side effects such as hypoventilation, nausea, and constipation. Three categories of medication useful for this multimodal analgesia are the nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and the α2-adrenergic agonists. Since their analgesic properties show a ceiling effect, they usually cannot be used as the sole agent for postoperative pain. These classes of medication provide pain relief via non-opioid pathways and are frequently combined with narcotics for additive effect. In addition, NSAIDs, acetaminophen, and α2-agonists have therapeutic uses distinct from pain relief, and their versatility makes them valuable tools in the perioperative period.
The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education... more The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education in anesthesiology mandate required rotations including rotations inside the operating room (OR). When residents complete rotations outside the OR, other providers must be used to maintain the OR's clinical productivity. WE QUANTIFIED AND COMPARED THE COSTS OF REPLACING RESIDENTS BY USING TWO DIFFERENT WORKING PATTERNS THAT ARE COMPLIANT WITH THE ACGME ANESTHESIOLOGY PROGRAM REQUIREMENTS: (1) the minimum amount of time in the OR, and (2) working the maximum amount of time permitted in the OR. We calculated resident replacement costs over a 36-month residency period in both a minimum and maximum OR time model. We used a range of Certified Registered Nurse Anesthetist (CRNA) pay scales determined by a local market analysis for cost comparisons. Depending on CRNA pay rates, the cost differentials to replace a resident in the OR between the minimum and maximum OR time models ranged from ...
Background The Accreditation Council for Graduate Medical Education has begun to evaluate teachin... more Background The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. Objective We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Methods Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Results Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patien...
Objectives To implement a 360-degree resident evaluation instrument on the postanesthesia care un... more Objectives 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. Methods 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 ...
Abstract Introduction While trainees are often introduced to a variety of drugs and anesthetic te... more Abstract Introduction While trainees are often introduced to a variety of drugs and anesthetic techniques, it is not typically accompanied by an informed discussion regarding their financial costs....
ABSTRACT Review the anatomy relevant to airway management Understand the components of an airway ... more ABSTRACT Review the anatomy relevant to airway management Understand the components of an airway examination Learn the principles of mask ventilation and intubation
There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests... more There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity (LF) versus high-fidelity haptic simulation for epidural anesthesia. No study, however, has compared the effect of LF haptic simulation for epidural anesthesia versus mental imagery (MI) training in which no physical practice is attempted. We tested the hypothesis that MI training is superior to LF haptic simulation training for epidural anesthesia skill acquisition. Twenty Post-Graduate Year 2 (PGY-2) anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into 2 groups. Group LF had LF simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted MI training in which they initially were oriented to the epidural kit components and epi...
Journal of Cardiothoracic and Vascular Anesthesia, 2021
OBJECTIVE The use of basic transesophageal echocardiography (TEE) in critically ill and older sur... more OBJECTIVE The use of basic transesophageal echocardiography (TEE) in critically ill and older surgical patients can change patient management and improve outcomes after noncardiac surgery. The authors hypothesized that educating the future generation on basic TEE skills by an intense two-month rotation will help them achieve basic TEE certification by the National Board of Echocardiography (NBE) and facilitate good use of their skills for patient care during their practice. DESIGN This is a descriptive report of graduating anesthesiology residents who completed two months basic TEE rotation at the authors' residency program between 2013 and 2019. The authors report the clinical training goals, NBE testamur and certification status, and a survey report on the use of basic TEE skills in their practice SETTINGS: University medical center. PARTICIPANTS Residents who completed two months basic TEE rotation during their Clinical Anesthesia (CA)-3 year. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of a total of 115 residents, 67 (58%) elected basic TEE rotation. The NBE basic TEE certification and testamur status were achieved by 12 (21%) and 14 (24%) eligible residents, respectively. Residents (n = 43) personally performed 73 ± 21 (mean ± standard deviation) and reviewed 72 ± 28 (mean ± standard deviation basic TEE studies before graduation. The survey indicated that 63.4% of residents trained in basic TEE did not use their skills in their practice. CONCLUSIONS Two months' basic TEE rotation was able to fulfill its educational goals (testamur status and clinical training) but fell short on achieving NBE certification rate and its ultimate impact on practice and patient care.
STUDY OBJECTIVE Physician burnout is a pervasive problem in the United States. The goal of this s... more STUDY OBJECTIVE Physician burnout is a pervasive problem in the United States. The goal of this study was to investigate use of the smartphone meditation application Headspace® as a well-being improvement tool in anesthesia trainees. DESIGN Prospective self-controlled observational study. SETTING Anesthesia training program in an academic hospital. SUBJECTS Resident and fellow trainees in the Department of Anesthesiology and Perioperative Medicine at the University of Pittsburgh Medical Center. INTERVENTIONS Resident and fellow trainees were given a free 1-year subscription to the mindfulness application. Participation was voluntary and included questionnaires at baseline, 1 month, and 4 months for assessment of burnout and well-being. Questionnaires were linked with the use of de-identified codes and completed via REDCap. Questionnaires included the abbreviated Maslach Burnout Inventory, Becks Depression Index, Cohens Stress Score, Pittsburgh Sleep Quality Index, and a Headspace® Self-Reporting Questionnaire. MEASUREMENTS Depression, stress, sleep quality, emotional exhaustion, depersonalization, and personal achievement. MAIN RESULTS Of 112 trainees eligible to participate, 71 completed baseline questionnaires, 54 created application accounts, and 29 completed the entire questionnaire protocol with 4 months of app use. Application use was associated with reduced depression scores and increased feelings of personal achievement at both 1 month (p = 0.003, p = 0.066) and 4 months (p = 0.011, p = 0.005). Burnout from feelings of depersonalization and emotional exhaustion did not improve with application use. Over the study period, trainees completed 786 meditation sessions, accounting for 6123 min of app engagement. CONCLUSIONS Findings of decreased depression scores and improved feelings of personal achievement suggest that Headspace® could serve as a mindfulness tool for incorporating meditation into the daily practice of anesthesia trainees in an effort to improve well-being.
Journal of Education in Perioperative Medicine, 2019
Results: Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more... more Results: Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more faculty involvement in resident didactic after implementing the financial incentive. The quality of lectures also improved after the incentive switch, according to resident evaluations. There were higher overall Likert scores in AY 2018 and a higher percentage of positive responses to the question of whether presenters should return in AY 2017 and AY 2018, compared with AY 2016. Conclusions: After implementation of a financial incentive in place of nonclinical time, more faculty became involved in lectures and overall lecture quality improved as measured by resident evaluations.
Background – Patient education improves treatment plan compliance and outcomes. For anesthesiolog... more Background – Patient education improves treatment plan compliance and outcomes. For anesthesiology residents, patient communication is highlighted on the obstetric subspecialty rotation. However, the clinical effectiveness of patient education on patient-controlled epidural analgesia (PCEA) dose requirements is unknown. We hypothesized that patients receiving care by residents who are formally instructed on patient education for PCEA, will have lower total local anesthetic consumption and higher satisfaction. Methods – A prospective, interrupted time series design was chosen. Residents participated in one of two sessions at the beginning of their two-month obstetric anesthesia rotation: 1) Education (E): residents taught how to educate patients on PCEA, followed by instructor-resident practice implementing a “teach-back” method for patient comprehension; 2) Control (C): no formal instruction on PCEA. Confidence in patient education was assessed at baseline and at the rotation end. T...
STUDY OBJECTIVE Physician burnout and suicide are at epidemic proportions. There is very little d... more STUDY OBJECTIVE Physician burnout and suicide are at epidemic proportions. There is very little data directly comparing resident versus faculty well-being. The 2017-2018 ACGME resident and faculty surveys mark the first time that well-being questions were included. The purpose of this study was to determine whether responses to ACGME well-being questions would differ significantly between anesthesiology residents and academic anesthesiology faculty. DESIGN 2017-2018 ACGME well-being survey responses. SETTING All eight Pennsylvania anesthesiology residency programs. PATIENTS None. INTERVENTIONS None. MEASUREMENTS The authors compared the 5-point Likert scale responses (1 = Never through 5 = Very Often) between residents (371/384 responses, 97%) and faculty (277/297 responses, 93%) for each of the twelve well-being questions. Responses were also dichotomized as being ≥4 versus <4 for categorical comparisons. MAIN RESULTS Faculty responded higher than residents both by mean scores and percent of scores ≥ 4 for 6/12 questions (questions 1 (p < 0.001), 2 (p < 0.001), 4 (p < 0.001), 5 (p < 0.001), 8 (p < 0.001), and 11 (p = 0.001)). Residents responded categorically higher for question 9 (p = 0.022) although this was not considered statistically significant. Residents responded lowest for "Reflected on how your work helps make the world a better place" (question 1), whereas the lowest faculty responses were for questions 1, 9, and 10. Both had high responses for "Had an enjoyable interaction with a patient" (question 11). CONCLUSIONS Pennsylvania academic anesthesiology faculty survey responses demonstrated a higher level of well-being compared to their residents. The variation in scoring suggests that anesthesiology residents and faculty have differing perceptions of various well-being domains. Information from well-being surveys can help provide programs with focus areas that they can intervene on to improve physician well-being.
Academic medicine : journal of the Association of American Medical Colleges, Jan 7, 2016
The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Enviro... more The Accreditation Council for Graduate Medical Education implemented the Clinical Learning Environment Review (CLER) program to evaluate and improve the learning environment in teaching hospitals. Hospitals receive a report after a CLER visit with observations about patient safety, among other domains, the accuracy of which is unknown. Thus, the authors set out to identify complementary measures of trainees' patient safety experience. In 2014, they administered the Hospital Survey on Patient Safety Culture to residents and fellows and general staff at 10 hospitals in an integrated health system. The survey measured perceptions of patient safety in 12 domains and incorporated two outcome measures (number of medical errors reported and overall patient safety). Domain scores were calculated and compared between trainees and staff. Of 1,426 trainees, 926 responded (65% response rate). Of 18,815 staff, 12,015 responded (64% response rate). Trainees and staff scored five domains simil...
The objective was to determine if there is a correlation between resident postgraduate year (PGY)... more The objective was to determine if there is a correlation between resident postgraduate year (PGY) of training and self-evaluation of performance using the Accreditation Council for Graduate Medical Education milestones. Survey. Residency program at a large academic center. Residents and Faculty Clinical Competency Committee (CCC). None. Resident and CCC milestone scores. Correlation coefficients for average score for each milestone vs PGY level ranged from 0.80 for receiving and giving feedback to 0.95 for anesthetic choice and conduct. All milestones showed a relatively linear relationship with PGY of training, and none were found to be consistently reached very late or very early in training. When examining variation across the scores for the individual residents, the distributions for PGY-2 and -3 appeared to be wider than those for PGY-1 and -4. The intraclass correlation coefficients ranged from 0.718 to 0.928. There was a remarkable degree of consistency in the relationship between level of training and resident self-assessment score for every milestone, as well as strong agreement between the resident and CCC faculty scores. Examination of the variance in the scores, when interpreted in light of our particular training program&amp;amp;amp;amp;amp;amp;amp;amp;#39;s characteristics, suggests that the milestones accurately reflect the progression in skill across the residency. In addition, given the concordance between the self-evaluation scores and the CCC faculty scores, self-evaluation may be a reasonable starting point as programs begin the daunting task of determining scores for each of the 25 milestones as part of the biannual evaluation process.
Do you need the book of A Case Approach to Perioperative Drug-Drug Interactions pdf with ISBN of ... more Do you need the book of A Case Approach to Perioperative Drug-Drug Interactions pdf with ISBN of 9781461474944? You will be glad to know that right now A Case Approach to Perioperative Drug-Drug Interactions pdf is available on our book collections. This A Case Approach to Perioperative Drug-Drug Interactions comes PDF and EPUB document format. If you want to get A Case Approach to Perioperative Drug-Drug Interactions pdf eBook copy, you can download the book copy here. The A Case Approach to Perioperative Drug-Drug Interactions we think have quite excellent writing style that make it easy to comprehend.
While narcotics remain the primary drug class for the treatment of perioperative pain, there is s... more While narcotics remain the primary drug class for the treatment of perioperative pain, there is strong interest in utilizing alternative analgesics with the goal of reducing narcotic-related side effects such as hypoventilation, nausea, and constipation. Three categories of medication useful for this multimodal analgesia are the nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and the α2-adrenergic agonists. Since their analgesic properties show a ceiling effect, they usually cannot be used as the sole agent for postoperative pain. These classes of medication provide pain relief via non-opioid pathways and are frequently combined with narcotics for additive effect. In addition, NSAIDs, acetaminophen, and α2-agonists have therapeutic uses distinct from pain relief, and their versatility makes them valuable tools in the perioperative period.
The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education... more The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education in anesthesiology mandate required rotations including rotations inside the operating room (OR). When residents complete rotations outside the OR, other providers must be used to maintain the OR's clinical productivity. WE QUANTIFIED AND COMPARED THE COSTS OF REPLACING RESIDENTS BY USING TWO DIFFERENT WORKING PATTERNS THAT ARE COMPLIANT WITH THE ACGME ANESTHESIOLOGY PROGRAM REQUIREMENTS: (1) the minimum amount of time in the OR, and (2) working the maximum amount of time permitted in the OR. We calculated resident replacement costs over a 36-month residency period in both a minimum and maximum OR time model. We used a range of Certified Registered Nurse Anesthetist (CRNA) pay scales determined by a local market analysis for cost comparisons. Depending on CRNA pay rates, the cost differentials to replace a resident in the OR between the minimum and maximum OR time models ranged from ...
Background The Accreditation Council for Graduate Medical Education has begun to evaluate teachin... more Background The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. Objective We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Methods Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Results Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patien...
Objectives To implement a 360-degree resident evaluation instrument on the postanesthesia care un... more Objectives 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. Methods 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 ...
Abstract Introduction While trainees are often introduced to a variety of drugs and anesthetic te... more Abstract Introduction While trainees are often introduced to a variety of drugs and anesthetic techniques, it is not typically accompanied by an informed discussion regarding their financial costs....
ABSTRACT Review the anatomy relevant to airway management Understand the components of an airway ... more ABSTRACT Review the anatomy relevant to airway management Understand the components of an airway examination Learn the principles of mask ventilation and intubation
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