Common data model for COVID-19 datasets.

MOTIVATION: A global medical crisis like the coronavirus disease 2019 (COVID-19) pandemic requires interdisciplinary and highly collaborative research from all over the world. One of the key challenges for collaborative research is a lack of interoperability among various heterogeneous data sources. Interoperability, standardization and mapping of datasets are necessary for data analysis and applications in advanced algorithms such as developing personalized risk prediction modeling. RESULTS: To ensure the interoperability and compatibility among COVID-19 datasets, we present here a common data model (CDM) which has been built from 11 different COVID-19 datasets from various geographical locations. The current version of the CDM holds 4639 data variables related to COVID-19 such as basic patient information (age, biological sex and diagnosis) as well as disease-specific data variables, for example, Anosmia and Dyspnea. Each of the data variables in the data model is associated with specific data types, variable mappings, value ranges, data units and data encodings that could be used for standardizing any dataset. Moreover, the compatibility with established data standards like OMOP and FHIR makes the CDM a well-designed CDM for COVID-19 data interoperability. AVAILABILITY AND IMPLEMENTATION: The CDM is available in a public repo here: https://github.com/Fraunhofer-SCAI-Applied-Semantics/COVID-19-Global-Model. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Defining and Addressing Anesthesiology Needs in Simulation-based Medical Education.

Background: This study's primary aim was to determine how training programs use simulation-based medical education (SBME), because SBME is linked to superior clinical performance. Methods: An anonymous 10-question survey was distributed to anesthesiology residency program directors across the United States. The survey aimed to assess where and how SBME takes place, which resources are available, frequency of and barriers to its use, and perceived utility of a dedicated departmental education laboratory. Results: The survey response rate was 30.4% (45/148). SBME typically occurred at shared on-campus laboratories, with residents typically participating in SBME 1 to 4 times per year. Frequently practiced skills included airway management, trauma scenarios, nontechnical skills, and ultrasound techniques (all ≥ 77.8%). Frequently cited logistical barriers to simulation laboratory use included COVID-19 precautions (75.6%), scheduling (57.8%), and lack of trainers (48.9%). Several respondents also acknowledged financial barriers. Most respondents believed a dedicated departmental education laboratory would be a useful or very useful resource (77.8%). Conclusion: SBME is a widely incorporated activity but may be impeded by barriers that our survey helped identify. Barriers can be addressed by departmental education laboratories. We discuss how such laboratories increase capabilities to support structured SBME events and how costs can be offset. Other academic departments may also benefit from establishing such laboratories.

A Nationwide Cross-Sectional Survey of Anesthesiology Fellowship Program Directors: Attitudes on Parental Leave in Residency and Fellowship Training.

Introduction: Little is known about the impact of parental leave on anesthesiology fellowship directors' perception of their fellows. In addition, use of parental leave during residency can result in "off-cycle" residents applying for a fellowship. This study sought to clarify fellowship directors' attitudes and beliefs on effects of parental leave on fellows and off-cycle fellowship applicants. Methods: An online survey was sent to anesthesiology fellowship program directors through e-mail addresses obtained from websites of the Accreditation Council for Graduate Medical Education and specialty societies. Descriptive statistical analysis was used. Results: In total, 101 fellowship directors (31% response rate) completed the survey. Forty-one (41%) directors had a fellow who took maternity leave in the past 3 years. Among the programs, 49 (49%) have a written policy about maternity leave and 36 (36%) have a written paternity or partner leave policy. Overall, most fellowship directors believed that becoming a parent had no impact on fellow performance and professionalism; more respondents perceived a greater negative impact on scholarly activities, standardized test scores, and procedural volume for female trainees than male trainees. Some fellowship directors (10/94; 11%) reported they do not allow off-cycle residents in their program. Among programs that allow off-cycle residents, more directors perceived it a disadvantage rather than an advantage. Conclusions: Fellowship directors perceive that anesthesiology residents who finish training outside the typical graduation cycle are at a disadvantage for fellowship training.

A cross-sectional survey study of United States residency program directors' perceptions of parental leave and pregnancy among anesthesiology trainees.

PURPOSE: Little is known about program directors' knowledge, attitudes, and beliefs regarding parental leave policies in anesthesiology training. This study sought to understand program director perceptions about the effects of pregnancy and parental leave on resident training, skills, and productivity. METHODS: An online 43-question survey was developed to evaluate United States anesthesiology program directors' perceptions of parental leave policies. The survey included questions regarding demographics, anesthesiology program characteristics, parental leave policies, call coverage, and the perceived effects of parental leave on resident performance. Data were collected by Qualtrics (Qualtrics, Provo, UT, USA). RESULTS: Fifty-six of 145 (39%) anesthesiology program directors completed the survey. Forty-eight of 54 (89%) program directors had a female resident take maternity leave in the past three years. When asked how parental leave affects residents' futures, 24/50 (48%) program directors felt it delayed board certification and 28/50 (56%) thought it affected fellowship opportunities. Program directors were split on their perceived impact of becoming a parent on a trainee's work. Yet, when compared with male trainees, program directors perceived that becoming a parent negatively affected female trainees' timeliness, technical skills, scholarly activities, procedural volume, and standardized test scores and affected training experience of co-residents. Program directors perceived no difference in impact on female trainees' dedication to patients and clinical performance. CONCLUSIONS: Program directors perceived that becoming a parent negatively affects the work performance of female but not male trainees. These negative perceptions could impact evaluations and future plans of female residents.

RéSUMé: OBJECTIF: On ne sait que peu de choses concernant les connaissances, les attitudes et les croyances des directeurs de programme au sujet des politiques relatives aux congés parentaux dans le cadre de la formation en anesthésiologie. Cette étude visait à comprendre les perceptions des directeurs de programme au sujet des effets de la grossesse et du congé parental sur la formation, les compétences et la productivité des résidents. MéTHODE: Un sondage en ligne comportant 43 questions a été élaboré afin d'évaluer les perceptions des directeurs de programme d'anesthésiologie aux États-Unis à l'égard des politiques en matière de congé parental. Le sondage comprenait des questions sur les données démographiques, les caractéristiques du programme d'anesthésiologie, les politiques relatives au congé parental, la couverture des gardes et les effets perçus du congé parental sur la performance des résidents. Les données ont été recueillies par Qualtrics (Qualtrics, Provo, UT, USA). RéSULTATS: Cinquante-six (39 %) des 145 directeurs de programme d'anesthésiologie ont répondu au sondage. Quarante-huit des 54 (89 %) directeurs de programme ont eu une résidente ayant pris un congé maternité au cours des trois dernières années. Lorsqu'on leur a demandé comment le congé parental affectait l'avenir des résidents, 24/50 (48 %) des directeurs de programme estimaient que cela retardait la certification médicale et 28/50 (56 %) pensaient que cela affectait les possibilités de fellowship. Les directeurs de programme étaient divisés quant à la question de l'impact perçu de devenir parent sur le travail d'un résident. Pourtant, par rapport aux résidents de sexe masculin, les directeurs de programme étaient d'avis que le fait de devenir parent affectait négativement les résidentes en matière de ponctualité, de compétences techniques, d'activités académiques, de volume procédural, de résultats aux tests standardisés et de l'expérience de formation de leurs co-résidents. Les directeurs de programme n'ont perçu aucune différence d'impact sur le dévouement des résidentes à l'égard de leurs patients ou sur leur performance clinique. CONCLUSION: Selon les directeurs de programme, le fait de devenir parent a une incidence négative sur la performance professionnelle des résidentes, mais non des résidents. Ces perceptions négatives pourraient avoir une incidence sur les évaluations et les plans futurs des résidentes.

Using Machine Learning to Evaluate Attending Feedback on Resident Performance.

BACKGROUND: High-quality and high-utility feedback allows for the development of improvement plans for trainees. The current manual assessment of the quality of this feedback is time consuming and subjective. We propose the use of machine learning to rapidly distinguish the quality of attending feedback on resident performance. METHODS: Using a preexisting databank of 1925 manually reviewed feedback comments from 4 anesthesiology residency programs, we trained machine learning models to predict whether comments contained 6 predefined feedback traits (actionable, behavior focused, detailed, negative feedback, professionalism/communication, and specific) and predict the utility score of the comment on a scale of 1-5. Comments with ≥4 feedback traits were classified as high-quality and comments with ≥4 utility scores were classified as high-utility; otherwise comments were considered low-quality or low-utility, respectively. We used RapidMiner Studio (RapidMiner, Inc, Boston, MA), a data science platform, to train, validate, and score performance of models. RESULTS: Models for predicting the presence of feedback traits had accuracies of 74.4%-82.2%. Predictions on utility category were 82.1% accurate, with 89.2% sensitivity, and 89.8% class precision for low-utility predictions. Predictions on quality category were 78.5% accurate, with 86.1% sensitivity, and 85.0% class precision for low-quality predictions. Fifteen to 20 hours were spent by a research assistant with no prior experience in machine learning to become familiar with software, create models, and review performance on predictions made. The program read data, applied models, and generated predictions within minutes. In contrast, a recent manual feedback scoring effort by an author took 15 hours to manually collate and score 200 comments during the course of 2 weeks. CONCLUSIONS: Harnessing the potential of machine learning allows for rapid assessment of attending feedback on resident performance. Using predictive models to rapidly screen for low-quality and low-utility feedback can aid programs in improving feedback provision, both globally and by individual faculty.

The "Difficult Learner" in anesthesiology: Challenges, pitfalls, and recommendations.

Struggling learners often require interventions that are time-consuming and emotionally exhausting for both the trainee and faculty. Numerous barriers, including lack of resources, faculty development, and fear of legal retribution, can impede medical educators from developing and implementing robust remediation plans. Despite the large volume of literature citing professionalism education and the "hidden curriculum" as problem areas in medical education, frontline educators lack practical tools and empowerment to address unprofessionalism in trainees. The paucity of resources in this arena has led to decreased job satisfaction, increased burnout, and an exodus from academic medicine. Department leadership acknowledgment and investment in training faculty on remediation strategies for learners in difficulty and providing tools to meet these challenging job demands will improve faculty's job satisfaction and overall well-being. The authors review salient literature and methodology for diagnosing learners in difficulty, with focus on a high-yield, pragmatic approach that can be taken by medical training programs, including those that lack a robust medical education infrastructure.

Be Active and Be Well? A Cross-sectional Survey of US Anesthesia Residents.

BACKGROUND: Wellness among resident physicians is important to their well-being and ability to provide clinical care. The relationship between physical activity and wellness among anesthesia residents has not yet been evaluated. We surveyed anesthesia residents to evaluate their levels of physical activity and self-perceived wellness scores. We hypothesized that residents with high self-reported physical activity levels would be more likely to have higher wellness scores. METHODS: Three hundred and twenty-three anesthesia residents were invited to participate in this cross-sectional survey study. The survey included questions regarding demographics (age, gender, clinical anesthesia year, work hours), physical activity (based off the US Department of Health and Human Services [USDHHS] guidelines), and wellness (using the Satisfaction With Life Scale). The relationship between wellness and physical activity levels was evaluated. RESULTS: One hundred forty-one residents responded (43.6% response rate). Thirty-eight (27.1%) residents met our activity threshold for physically active. Eighty-six respondents (61.4%) were classified as having high wellness based on their survey answers. No significant associations were found between demographic data and wellness, including age or clinical anesthesia training year. Among those residents who described physical activity consistent with USDHHS guidelines, 29 (76.3%) had high wellness scores. After logistic regression analysis, residents who achieved the physical activity guidelines were more likely to have high wellness scores (odds ratio 2.54, 95% confidence interval 1.13-6.20, P value .03). CONCLUSIONS: Anesthesia resident physicians with high physical activity levels had higher self-perceived wellness scores.

Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) may be complicated by postoperative pain, nausea, and vomiting, with consequent increases in length of stay (LOS), decreased patient satisfaction, and higher costs. While enhanced recovery after surgery (ERAS) protocols have been in circulation for many years, there is no standard ERAS protocol for bariatric surgery. METHODS: Data were collected prospectively and compared to a historical control. All patients undergoing LSG, ages 18 to 75, were included in the pathway; those with preoperative chronic opioid use were excluded from our results. Statistical analysis was performed using t-statistics and chi-squared test. Ninety patients undergoing LSG, performed by a single surgeon, were included in our ERAS group from November 26, 2018, to April 30, 2019, and were compared to a historical control of 570 patients who underwent LSG over the previous 5 years (pre-ERAS). Measured outcomes included discharge opioid prescriptions issued, hospital length of stay, 30-day readmissions, reoperations, morbidity, and mortality. RESULTS: Ten (11%) ERAS patients vs 100% of pre-ERAS patients received opioid prescriptions upon, or after, discharge (p < 0.001). The ERAS group LOS decreased to 1.36 days vs 2.40 days in the pre-ERAS group (p < 0.001). 30-day readmission rates were 0% for ERAS patients vs 3.09% for pre-ERAS patients (p = 0.149). 30-day reoperation rates were 0% for ERAS patients vs 0.54% for pre-ERAS patients (p = 1). Thirty-day morbidity rates were 3.33% (3) for ERAS patients vs 3.27% for pre-ERAS patients (p = 1); there was no 30-day mortality in either group. CONCLUSION: ERAS for LSG results in a clinical and statistically significant reduction in postoperative opioid use and LOS, without increasing 30-day readmissions, reoperations, morbidity, or mortality.

An International Exploration of the Effect of Media Portrayals of Postconcussion Management on Concussion Identification in the General Public.

BACKGROUND: Concussion portrayal in media broadcasts of sporting events may contribute to lack of public understanding regarding concussion. METHODS: In total, 828 participants from Australia, New Zealand, and the United Kingdom completed a questionnaire assessing concussion knowledge. Participants were randomly assigned to either receive sports return-to-play (RTP) guideline information (RTP group) or not (no-RTP group). Participants viewed 12 short clips from televised rugby games and indicated whether they believed the player in each clip had sustained a concussion. Participants were then informed whether the player was removed, returned, or stayed in the game and again asked whether they thought a concussion had occurred. RESULTS: Probability of reporting a likely concussion over all videos was 65.6%. When told a player's possible concussion was managed by removal from the game, participants were more likely to change their response from "no" (no concussion) to "yes" (concussion) than from "yes" to "no." When told the player stayed or returned to the game, participants were more likely to change their response from "yes" (concussion) to "no" (no concussion) than from "no" to "yes." There was no significant main effect for RTP guideline manipulation or interaction effect with RTP information. CONCLUSION: Additional player's injury management information influenced participants' judgments of concussion occurrence. Results show that information provided via sports media broadcasts influenced viewers' perceptions of concussion and appropriate concussion management.

Customizable Curriculum to Enhance Resident Communication Skills.

Communication remains challenging to teach and evaluate. We designed an online patient survey to assess anesthesia residents' communication skills from August 2014 to July 2015. In December 2014, we implemented a customized, simulation-based curriculum. We calculated an overall rating for each survey by averaging the ratings for the individual questions. Based on the Hodges-Lehmann 2-sample aligned rank-sum test, overall ratings, reported as the median (interquartile range) of residents' average overall ratings, differed significantly between the preintervention (3.86 [3.76-3.94]) and postintervention (3.91 [3.84-3.95]) periods (P = .025). Future studies should assess the intervention's effectiveness and generalizability.

Learning Preferences of First-Year Anesthesiology Residents During Their Orientation Month: A Single-Institution Study.

As a step toward understanding whether learning preferences may benefit trainees and instructors, we studied the learning preferences, based on the VARK questionnaire, of anesthesiology residents during their orientation month to determine whether knowing their preferences influenced the educational resources they used. While resource utilization was similar for residents who knew their preferences and those who did not, residents overall used aural and read/write resources frequently. The learning preferences of 13 residents (72.2%) changed during the month. While further research is needed, this study provides insight into anesthesiology residents' learning styles.

Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents.

BACKGROUND: In a flipped classroom approach, learners view educational content prior to class and engage in active learning during didactic sessions. OBJECTIVE: We hypothesized that a flipped classroom improves knowledge acquisition and retention for residents compared to traditional lecture, and that residents prefer this approach. METHODS: We completed 2 iterations of a study in 2014 and 2015. Institutions were assigned to either flipped classroom or traditional lecture for 4 weekly sessions. The flipped classroom consisted of reviewing a 15-minute video, followed by 45-minute in-class interactive sessions with audience response questions, think-pair-share questions, and case discussions. The traditional lecture approach consisted of a 55-minute lecture given by faculty with 5 minutes for questions. Residents completed 3 knowledge tests (pretest, posttest, and 4-month retention) and surveys of their perceptions of the didactic sessions. A linear mixed model was used to compare the effect of both formats on knowledge acquisition and retention. RESULTS: Of 182 eligible postgraduate year 2 anesthesiology residents, 155 (85%) participated in the entire intervention, and 142 (78%) completed all tests. The flipped classroom approach improved knowledge retention after 4 months (adjusted mean = 6%; P = .014; d = 0.56), and residents preferred the flipped classroom (pre = 46%; post = 82%; P < .001). CONCLUSIONS: The flipped classroom approach to didactic education resulted in a small improvement in knowledge retention and was preferred by anesthesiology residents.

Enhancing Feedback on Professionalism and Communication Skills in Anesthesia Residency Programs.

BACKGROUND: Despite its importance, training faculty to provide feedback to residents remains challenging. We hypothesized that, overall, at 4 institutions, a faculty development program on providing feedback on professionalism and communication skills would lead to (1) an improvement in the quantity, quality, and utility of feedback and (2) an increase in feedback containing negative/constructive feedback and pertaining to professionalism/communication. As secondary analyses, we explored these outcomes at the individual institutions. METHODS: In this prospective cohort study (October 2013 to July 2014), we implemented a video-based educational program on feedback at 4 institutions. Feedback records from 3 months before to 3 months after the intervention were rated for quality (0-5), utility (0-5), and whether they had negative/constructive feedback and/or were related to professionalism/communication. Feedback records during the preintervention, intervention, and postintervention periods were compared using the Kruskal-Wallis and χ tests. Data are reported as median (interquartile range) or proportion/percentage. RESULTS: A total of 1926 feedback records were rated. The institutions overall did not have a significant difference in feedback quantity (preintervention: 855/3046 [28.1%]; postintervention: 896/3327 [26.9%]; odds ratio: 1.06; 95% confidence interval, 0.95-1.18; P = .31), feedback quality (preintervention: 2 [1-4]; intervention: 2 [1-4]; postintervention: 2 [1-4]; P = .90), feedback utility (preintervention: 1 [1-3]; intervention: 2 [1-3]; postintervention: 1 [1-2]; P = .61), or percentage of feedback records containing negative/constructive feedback (preintervention: 27%; intervention: 32%; postintervention: 25%; P = .12) or related to professionalism/communication (preintervention: 23%; intervention: 33%; postintervention: 24%; P = .03). Institution 1 had a significant difference in feedback quality (preintervention: 2 [1-3]; intervention: 3 [2-4]; postintervention: 3 [2-4]; P = .001) and utility (preintervention: 1 [1-3]; intervention: 2 [1-3]; postintervention: 2 [1-4]; P = .008). Institution 3 had a significant difference in the percentage of feedback records containing negative/constructive feedback (preintervention: 16%; intervention: 28%; postintervention: 17%; P = .02). Institution 2 had a significant difference in the percentage of feedback records related to professionalism/communication (preintervention: 26%; intervention: 57%; postintervention: 31%; P < .001). CONCLUSIONS: We detected no overall changes but did detect different changes at each institution despite the identical intervention. The intervention may be more effective with new faculty and/or smaller discussion sessions. Future steps include refining the rating system, exploring ways to sustain changes, and investigating other factors contributing to feedback quality and utility.

Recognition of a Thoracic Epidural Hematoma in the Setting of Transient Paralysis: A Case Report.

A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.

The Impact of a Resident Communication Skills Curriculum on Patients' Experiences of Care.

Despite the high impact of lapses in communication skills on patient care, these skills are often not explicitly taught in residency training programs. We implemented a simulation and web-based curriculum in communication for anesthesia residents and used a patient survey adapted from the Four Habits Coding Scheme to detect changes in patient feedback on residents' communication skills after the curricular intervention. Postintervention mean ratings of residents for the overall survey were higher than preintervention mean ratings. Future research will focus on assessing the curriculum's effectiveness and exploring the generalizability of the survey and curriculum.