RESUMO
ABSTRACT: A central goal of precision education (PE) is efficiently delivering the right educational intervention to the right learner at the right time. This can be achieved through a PE cycle that involves gathering inputs, using analytics to generate insights, planning and implementing interventions, learning and assessing outcomes, and then using lessons learned to inform modifications to the cycle. In this paper, the authors describe 3 PE initiatives utilizing this cycle. The Graduate Medical Education Laboratory (GEL) uses longitudinal data on graduate trainee behavior, clinical skills, and wellness to improve clinical performance and professional fulfillment. The Transition to Residency Advantage (TRA) program uses learner data from medical school coupled with individualized coaching to improve the transition to residency. The Anesthesia Research Group for Educational Technology (TARGET) is developing an automated tool to deliver individualized education to anesthesia residents based on a longitudinal digital representation of the learner. The authors discuss strengths of the PE cycle and transferrable learnings for future PE innovations. Common challenges are identified, including related to data (e.g., volume, variety, sharing across institutions, using the electronic health record), analytics (e.g., validating augmented intelligence models), and interventions (e.g., scaling up learner assessments with limited resources). PE developers need to share their experiences in order to overcome these challenges, develop best practices, and ensure ethical development of future systems. Adapting a common framework to develop and assess PE initiatives will lead to a clearer understanding of their impact, help to mitigate potential risks, and allow deployment of successful practices on a larger scale.
Assuntos
Internato e Residência , Tutoria , Humanos , Educação de Pós-Graduação em MedicinaRESUMO
Focused Assessment with Sonography in Trauma (FAST) examinations have been performed for decades by surgeons during initial patient presentation for emergency care and surgical planning, as well as for guiding resuscitation. This case highlights how use of intraoperative FAST examinations performed by anesthesiologists can dramatically change patient management. Use by anesthesiologists perioperatively is an important skill, although it is not widely practiced.
Assuntos
Serviços Médicos de Emergência , Avaliação Sonográfica Focada no Trauma , Humanos , Anestesiologistas , Sistemas Automatizados de Assistência Junto ao Leito , UltrassonografiaRESUMO
While transesophageal echocardiography (TEE) has traditionally been used in perioperative care, there is growing evidence supporting point of care ultrasound (POCUS) for the anesthesiologist in guiding patient care. It is a quick way to non-invasively evaluate hemodynamically unstable patients and ascertain their state of shock, determine volume status, and guide resuscitation in cardiac arrest. In addition, through use of POCUS, the anesthesiologist is able to identify signs of chronic heart disease to provide a more tailored and safer approach to perioperative care.
Assuntos
Anestesiologia , Cardiopatias , Assistência Perioperatória , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Humanos , Parada Cardíaca/diagnóstico por imagem , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Hemodinâmica/fisiologia , Ultrassonografia/métodos , Assistência Perioperatória/métodos , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Doença Crônica , Volume Sanguíneo , Choque/diagnóstico por imagem , Choque/fisiopatologia , Anestesiologia/métodosRESUMO
Aortoatrial fistula formation is a rare complication of bacterial endocarditis. Fistulous tracts may form between the aorta and either atrium. Clinical presentation varies from an insignificant murmur to refractory congestive heart failure. Most clinically relevant fistula manifests with acute and severe symptoms. Transesophageal echocardiography (TEE) is more sensitive than transthoracic echocardiography (TTE) in diagnosing intracardiac shunts, and invaluable in guiding intraoperative surgical repair. Definitive therapy involves closure of the fistula either through an open surgical approach or percutaneously with an occluder device.
Assuntos
Ecocardiografia Transesofagiana/métodos , Endocardite/complicações , Fístula/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Aorta/patologia , Feminino , Fístula/cirurgia , Átrios do Coração/patologia , Cardiopatias Congênitas/fisiopatologia , Humanos , Pessoa de Meia-Idade , Dispositivo para Oclusão Septal/efeitos adversos , Resultado do TratamentoAssuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Corpos Estranhos/complicações , Corpos Estranhos/terapia , Idoso , Anestesia/métodos , Broncoscopia , Feminino , Tecnologia de Fibra Óptica , Humanos , Intubação Intratraqueal , Lesões do Pescoço/complicações , Lesões do Pescoço/terapiaAssuntos
Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Alvéolos Pulmonares/diagnóstico por imagem , Alvéolos Pulmonares/fisiopatologia , Ultrassonografia/métodos , Humanos , Hipóxia/complicações , Complicações Intraoperatórias/fisiopatologia , Pulmão , Atelectasia Pulmonar/complicações , Atelectasia Pulmonar/diagnóstico por imagemRESUMO
We present a case of a 41-year-old man who suffered cardiac arrest after induction of general anesthesia for an ambulatory ophthalmologic procedure. In this report, we highlight the use of focused transthoracic echocardiography by the anesthesia team to guide a prolonged resuscitation. Emergency room and critical care physicians have described the use of focused echocardiography to aid in diagnosing correctible causes of cardiac arrest, predicting outcomes, and in decision making regarding termination of resuscitation. We discuss benefits and barriers to anesthesiologists incorporating focused cardiac ultrasound into the perioperative arena.