Changing the Culture: Increasing and Sustaining Anesthesiology Resident Physician Publication Rates.

Background: Academic inquiry is foundational to the advancement of medicine and resident training and must be demonstrated to the Accreditation Council for Graduate Medical Education. Past attempts at increasing publication rates have failed to identify educational best practice models. Our aim was to increase resident publication rates via culture and value changes that are universally implementable, affordable, effective, and sustainable. Methods: In 2018, a multifaceted initiative was implemented to shift departmental values and foster a culture of academic productivity. This culture change stressed the value of scientific publication through frequent, consistent messaging from department leaders. In addition, residents were provided the freedom to choose their scholarly activities. In this retrospective cohort innovation, resident authors were identified for 4 academic years before and after the intervention and publication rates were determined (2014-2018 vs 2018-2022). Resident authors and publications per resident per year were compared using descriptive statistics and Student t test. Results: The pre- and postintervention groups included 38 and 37 residents, respectively. Resident-authored publications increased from 7 preintervention to 24 postintervention, representing 343% of baseline. Mean ± SD publications per resident per year similarly increased 357% from 0.183 ± 0.16 to 0.654 ± 0.11 postintervention. Unpaired t test analysis demonstrated a significant difference in total publications per year (P = .002) and authorship rate (P = .003). Conclusions: A multifaceted academic initiative resulted in a threefold increase in resident publication rates. This initiative demonstrates that local advocacy by leaders, freedom of choice for authors, and supportive departmental culture are driving factors in publication rates.

Table tipping and a near-miss fall after unlocking a surgical table holding a morbidly obese patient.

Presented is a case report of a morbidly obese patient who experienced a near-miss fall in the operating room due to several factors. We present the importance of recognizing the change in fulcrum location on a Steris 4085 operating table when the bed is in the unlocked versus the locked position. This small change, in the presence of morbid obesity and reverse orientation of the table, can lead to an unsafe situation in which the patient's weight can cause the table to tip. We present potential ways to avoid this complication.

Two loose screws: near-miss fall of a morbidly obese patient after an operating room table failure.

Operating room surgical table failure is a rare event but can lead to a dangerous situation when it does occur. The dangers can be compounded in the presence of obesity, especially in the anesthetized or sedated patient. We present a case of a near-miss fall of a morbidly obese patient while turning the patient in preparation to transfer from the operating room table to the hospital bed when 2 fractured bolts in the tilt cylinder mechanism led to an operating room table failure.

A national cross-sectional survey of social networking practices of U.S. anesthesiology residency program directors.

STUDY OBJECTIVE: To determine the social networking practices of directors of anesthesiology residency programs. DESIGN: Cross-sectional survey. SETTING: Online and paper survey tool. SUBJECTS: 132 anesthesiology residency program directors in the United States. MEASUREMENTS: A 13-item survey including dichotomous and multiple choice responses was administered using an online survey tool and a paper survey. Data analysis was conducted by descriptive and analytical statistics (chi-square test). A P-value < 0.05 indicated statistical significance. MAIN RESULTS: 50% of anesthesiology program directors responded to the survey (66/132). Policies governing social networking practices were in place for 30.3% (n=20) of the programs' hospitals. The majority of program directors (81.8%, 54) reported never having had an incident involving reprimand of a resident or fellow for inappropriate social networking practices. The majority (66.7%, n=44) of responding programs reported that departments did not provide lectures or educational activities related to appropriate social networking practices. Monitoring of social networking habits of residents/fellows by program directors mainly occurs if they are alerted to a problem (54.5%, n=36). Frequent use of the Internet for conducting searches on a resident applicant was reported by 12.1% (n=8) of program directors, 30.3% (n=20) reported use a few times, and 57.6% (n=38) reported never using the Internet in this capacity. CONCLUSION: Residency programs should have a written policy related to social media use. Residency program directors should be encouraged to become familiar with the professionalism issues related to social media use in order to serve as adequate resident mentors within this new and problematic aspect of medical ethics and professionalism.

Recurrent persistent hiccups after epidural steroid injection and analgesia with bupivacaine.

This case report presents a patient who developed persistent hiccups after epidural administration of dilute bupivacaine on several different occasions. Substitution of saline for the dilute bupivacaine during epidural steroid injection did not result in hiccups; however, subsequent postoperative epidural analgesia with bupivacaine caused a recurrence of the hiccups.