Impact of the COVID-19 pandemic on anaesthesia trainees and their training.

Coronavirus disease 2019 (COVID-19; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] has dislocated clinical services and postgraduate training. To better understand and to document these impacts, we contacted anaesthesia trainees and trainers across six continents and collated their experiences during the pandemic. All aspects of training programmes have been affected. Trainees report that reduced caseload, sub-specialty experience, and supervised procedures are impairing learning. Cancelled educational activities, postponed examinations, and altered rotations threaten progression through training. Job prospects and international opportunities are downgraded. Work-related anxieties about provision of personal protective equipment, and risks to self and to colleagues are superimposed on concerns for family and friends and domestic disruption. These seismic changes have had consequences for well-being and mental health. In response, anaesthetists have developed innovations in teaching and trainee support. New technologies support trainer-trainee interactions, with a focus on e-learning. National training bodies and medical regulators that specify training and oversee assessment of trainees and their progression have provided flexibility in their requirements. Within anaesthesia departments, support transcends grades and job titles with lessons for the future. Attention to wellness, awareness of mental health issues and multimodal support can attenuate but not eliminate trainee distress.

Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training.

Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education course in collaboration with the World Federation of Societies of Anaesthesiologists to address this training gap. We aimed to evaluate the impact of this course among Kenyan participants. Mixed methodologies and secondary analyses of anonymised data were used to study translation of learning into practice. In total, 103 participants from 66 facilities who attended courses between 2016 and 2017 were analysed. Ninety (87%) participants who were followed up completed knowledge tests. Baseline median (IQR [range]) knowledge test score was 41 (37-43 [21-46]). There was a significant improvement in median (IQR [range]) knowledge test score immediately post-course (43 (41-45 [33-48]); p < 0.001) which was sustained at 3-6 month follow-up (43 (41-45 [32-50]); p < 0.001 compared with baseline). Eighty-four of the 103 participants were observed in their workplace and capability, opportunity and motivation-behaviour framework was used to study the barriers and facilitators to practice change. Psychological capability and reflective motivation were the main factors enabling positive behaviour change such as team communication and pre-operative assessment, whereas physical and social opportunity accounted for the main barriers to behaviours such as performing the surgical safety checklist. Our study demonstrates that the Safe Anaesthesia from Education obstetric course is relevant in the low-resource setting and may lead to knowledge translation in clinical practice.

Non-technical skills and otolaryngology: systematic review.

OBJECTIVES: This study aimed to assess the published literature on non-technical skills in otolaryngology surgery and examine the applicability of any research to others' practice, and to explore how the published literature can identify areas for further development and guide future research. METHODS: A systematic review was conducted using the following key words: 'otolaryngology', 'otorhinolaryngology', 'ENT', 'ENT surgery', 'ear, nose and throat surgery', 'head and neck surgery', 'thyroid surgery', 'parathyroid surgery', 'otology', 'rhinology', 'laryngology' 'skull base surgery', 'airway surgery', 'non-technical skills', 'non technical skills for surgeons', 'NOTSS', 'behavioural markers' and 'behavioural assessment tool'. RESULTS: Three publications were included in the review - 1 randomised, controlled trial and 2 cohort studies - involving 78 participants. All were simulation-based studies involving training otolaryngology surgeons. CONCLUSION: Little research has been undertaken on non-technical skills in otolaryngology. Training surgeons' non-technical skill levels are similar across every tested aspect. The research already performed can guide further studies, particularly amongst non-training otolaryngology surgeons and in both emergency and elective non-simulated environments.

Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers' perspectives.

OBJECTIVES: To explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries. DESIGN: This was a qualitative exploratory descriptive study. Semistructured interviews were conducted online, recorded, transcribed and analysed thematically using NVivo. SETTING: Participants' homes or workplaces in Sierra Leone, Somaliland and Uganda. PARTICIPANTS: 15 NPAPs, physician anaesthetists and surgeons working in the countries concerned. RESULTS: Three major themes were identified: (1) discrepancy between urban training and rural practice, (2) prominent development of attitudes outside the curricular set during training, including approaches to learning and clinical responsibility and (3) the importance of interprofessional relationships developed during training for later practice. CONCLUSIONS: Anaesthesia providers in different cadres and very different country contexts in sub-Saharan Africa describe common themes in training which appear to be significant for their later practice. Not all these issues are explicitly planned for in current training programmes, although they are important in the view of providers. Subsequent programme development should consider these themes with a view to enhancing the safety and quality of anaesthesia practice in this context.

[Which medications are safe while breastfeeding? : A synopsis for the anesthetist, obstetrician and pediatrician]. / Welche Medikamente sind in der Stillzeit erlaubt? : Eine Übersicht für den Anästhesisten, Geburtshelfer und Kinderarzt.

Pharmacokinetic data on drug administration during lactation are often inconsistent or missing. For legal reasons medicinal drug product information generally advises to interrupt breastfeeding for 24 h after medication intake. However this is not standard of care in clinical practice as the mother should be instructed to initiate breastfeeding as soon as possible after giving birth. At the same time the medication exposure over the breast milk for the newborn should be minimized. Aim of this article is to summarize pharmacokinetic data and to give important clinical information on medications frequently administered during the lactation period. As a general rule a mother can start breastfeeding following anesthesia as soon as she is able to get her baby latched on her breast.

Comunicación de malas noticias: perspectivas desde la anestesiología / How to tell bad news in anesthesiology

Objetivo: Desarrollar las habilidades de comunicación, dado que estas pueden producir un impacto positivo tanto en el dador como en el receptor de malas noticias. Conocer, mejorar y reforzar las técnicas en la transmisión de malas noticias. La comunicación de malas noticias es una práctica inherente al acto médico, si bien no nos enfrentamos habitualmente como anestesiólogos, es una de las tareas más difíciles a las que estamos expuestos. El hecho de no estar preparados para ello puede comprometer las competencias que necesitamos para hacerlo adecuadamente, lo que es fundamental conjuntamente con el mantenimiento de una adecuada relación médico paciente. La medicina paternalista ha dejado de ser tal, para dar lugar a nuevas formas de modelos de atención, poniéndose énfasis en la opinión y participación del paciente (empoderamiento) en la toma de decisiones. Transmitir una mala noticia de forma inadecuada, es decir, de forma drástica y sin empatizar con la situación que vive el paciente, hace que el médico ejerza esa tarea de manera áspera y errática. Acercarse a una persona o una familia con una mala noticia, sin un plan adecuado para presentar la información en forma estructurada, es casi una garantía de que se generará mayor dolor emocional y la alteración de los receptores de la noticia. Conclusión: La mayoría de los profesionales médicos no han recibido educación para dar malas noticias, pero casi todos se enfrentan frecuentemente al hecho. De ahí la importancia de estar preparados para esta responsabilidad, por lo que necesitamos formación para hacerlo de manera adecuada y profesional.

Objective: To learn communication skills, as they can have a positive impact on both the donor and the recipient of the bad news. To know, to improve and to reinforce the techniques of transmission of bad news. The communication of bad news is an inherent practice of the medical act, although normally we do not face as anesthetists, it is one of the most difficult tasks to which we are exposed. Not being prepared for it can compromise the human and technical skills we need to do it correctly, which is fundamental in conjunction with maintaining an adequate patient medical relationship. Paternalistic medicine has ceased to be such, to give rise to new forms of models of care, with an emphasis on the opinion and participation of the patient in decision making. To transmit bad news in an inadequate way, that is to say, drastically and without empathizing with the situation that the patient lives, causes the doctor to perform this task in a rude and erratic way. Approaching a person or a family with bad news, without a suitable plan to present the information in a structured way, is almost a guarantee that will generate more emotional pain and alteration of the news recipients. Conclusion: Most medical professionals have not been educated to give bad news, but almost all often face the fact. Hence the importance of being prepared for this responsibility, so we need training to do it properly and professionally.

Education, Practice, and Competency Gaps of Anesthetists in Ethiopia: Task Analysis.

PURPOSE: This study assessed the needs and gaps in the education, practice and competencies of anesthetists in Ethiopia. DESIGN: A cross-sectional study design was used. METHODS: A questionnaire consisting of 74 tasks was completed by 137 anesthetists who had been practicing for 6 months to 5 years. FINDINGS: Over half of the respondents rated 72.9% of the tasks as being highly critical to patient outcomes, and reported that they performed 70.2% of all tasks at a high frequency. More than a quarter of respondents reported that they performed 15 of the tasks at a low frequency. Nine of the tasks rated as being highly critical were not learned during pre-service education by more than one-quarter of study participants, and over 10% of respondents reported that they were unable to perform five of the highly critical tasks. CONCLUSIONS: Anesthetists rated themselves as being adequately prepared to perform a majority of the tasks in their scope of practice.

Oral and Maxillofacial Surgery Team Anesthesia Model and Anesthesia Assistant Training.

The model for oral and maxillofacial surgery (OMFS) delivery of office-based, open airway anesthesia has morphed from the operator-anesthetist to the delivery of team anesthesia, supporting a widespread focus on organizational aspects of the delivery of care. The training, continuing education, and coordination of a diverse anesthesia team provides a system to improve the safety and efficacy of anesthesia delivery. The hallmarks of this system include communication, checks and balances, monitoring, team dynamics, protocols, emergency scenario preparation and rehearsal, and crisis resource management during an emergent situation. This system contributes to and continually supports a culture of safety in the OMFS office.

Interacción farmacológica de los bloqueadores neuromusculares con fármacos de uso anestesiológico / Neuromuscular-blocking drugs interaction with drugs used in anesthesiology

Introducción: Se entiende por interacción farmacológica la capacidad que tiene un fármaco de alterar los efectos farmacológicos de otro que se administre simultáneamente. Objetivo: Realizar una revisión actualizada de la interacción farmacológica de los bloqueadores neuromusculares con fármacos de uso frecuente en el ámbito anestesiológico. Desarrollo: Los mecanismos de interacción medicamentosa son variados y se complican cuando se trata de modificaciones sobre las propiedades farmacocinéticas y farmacodinámicas de cada medicamento. Los bloqueadores neuromusculares (BNM) son fármacos que se utilizan para relajar la musculatura estriada y garantizar la intubación traqueal, la ventilación y producir un plano quirúrgico suficiente para que el cirujano pueda realizar de forma adecuada el procedimiento quirúrgico. Muchos medicamentos interactúan con los BNM y con frecuencia potencian el efecto relajante muscular. Esto resulta de importancia clínica en el caso de antibióticos, anestésicos inhalatorios, litio y ciclosporina. Conclusiones: El anestesiólogo moderno debe tener suficientes conocimientos teóricos sobre las diferentes interacciones medicamentosas que se pueden presentar en el perioperatorio. Los bloqueadores neuromusculares pueden interactuar con fármacos de uso común por los pacientes o por el anestesiólogo, por lo que es necesario el diagnóstico precoz y el tratamiento adecuado para evitar las complicaciones(AU)

Introduction: Drug interaction is understood as the ability of a drug for altering the pharmacological effects of another simultaneously administered. Objective: To carry out an updated review about the drug interaction of neuromuscular-blocking drugs with others frequently used in the anesthesiological field. Findings: The mechanisms of drug interaction are varied and are complicated in cases of modifications on the pharmacokinetical and pharmacodynamical properties of each medicine. Neuromuscular-blocking drugs (NMBs) are used to relax the striated musculature and to ensure tracheal intubation, ventilation. They produce a sufficient surgical plane in order for the surgeon to perform the surgical procedure properly. Many medications interact with NMBs and often potentiate the muscle relaxant effect. This is of clinical importance in the case of antibiotics, inhalational anesthetics, lithium and cyclosporine. Conclusions: Modern anesthesiologists must have sufficient theoretical knowledge about different drug interactions that may occur during the perioperative period. Neuromuscular-blocking drugs can interact with others commonly used by patients or by the anesthesiologists, a reason why early diagnosis and appropriate treatment are necessary to avoid complications(AU)

The College of Anaesthetists of Ireland Simulation Training programme: a descriptive report and analysis of course participants' feedback.

BACKGROUND: Simulation-based education is a modern training modality that allows healthcare professionals to develop knowledge and practice skills in a safe learning environment. The College of Anaesthetists of Ireland (CAI) was the first Irish postgraduate medical training body to introduce mandatory simulation training into its curriculum. Extensive quality assurance and improvement data has been collected on all simulation courses to date. AIMS: Describe The College of Anaesthetists of Ireland Simulation Training (CAST) programme and report the analysis of course participants' feedback. METHODS: A retrospective review of feedback forms from four simulation courses from March 2010 to August 2016 took place. Qualitative and quantitative data from 1069 participants who attended 112 courses was analysed. RESULTS: Feedback was overall very positive. Course content and delivery were deemed to be appropriate. Participants agreed that course participation would influence their future practice. A statistically significant difference (P < 0.001) between self-reported pre- and post-course confidence scores was observed in 19 out of 25 scenarios. The learning environment, learning method and debrief were highlighted as aspects of the courses that participants liked most. CONCLUSIONS: The mandatory integration of CAST has been welcomed with widespread enthusiasm among specialist anaesthesia trainees. Intuitively, course participation instils confidence in trainees and better equips them to manage anaesthesia emergencies in the clinical setting. It remains to be seen if translational outcomes result from this increase in confidence. Nevertheless, the findings of this extensive review have cemented the place of mandatory simulation training in specialist anaesthesia training in Ireland.

Anesthesia Development in Mongolia: Strengthening Anesthesia Practice in Mongolia Through Education and Continuing Professional Development.

Anesthesia in Mongolia has undergone a period of major development over the past 17 years, thanks to the work of the Mongolian Society of Anesthesiologists (MSA) and the support of the World Federation of Societies of Anaesthesiologists and the Australian Society of Anaesthetists. The specialty has made major advances in training and in its standing among medical specialties in Mongolia. The MSA has produced members who are leaders in the development of anesthesia as well as emergency medicine and critical care. This has been achieved by engagement between the Ministry of Health and MSA, and with inexpensive but efficient programs to educate trainees and provide continuing professional development. There is now major work being done to achieve the Lancet Commission on Global Surgery goals of safe and accessible surgery for the population in a country that faces significant challenges of remote communities with vast distances.

Education: The Heart of the Matter.

There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program. In some countries, nonuniversity programs may be appropriate for training providers.(2) It is essential to train local teachers-a number of short courses provide teacher training. Overseas attachments may also play an important role in developing leadership and teaching capacity.(3) Interactive teaching techniques, such as small-group discussions and simulation, have been incorporated into many educational programs. Computer learning and videoconferencing offer additional educational possibilities.(4) Subspecialty education in areas such as obstetric anesthesia, pediatric anesthesia, and pain management are needed to develop leadership and increase capacity in subspecialty areas of practice. Examples include short subspecialty courses and clinical fellowships.(5) Collaboration and coordination are vital. Anesthesiologists need to work with ministries of health and other organizations to develop plans that are matched to need. External organizations can play an important role.(6) Excellent education is required at all levels. Training guidelines could help to standardize and improve training. Resources should be available for research, as well as monitoring and evaluation of educational programs.

Are Short Subspecialty Courses the Educational Answer?

There is an urgent need to train more anesthesia providers in low- and middle-income countries (LMICs). There is also a need to provide more educational opportunities in subspecialty areas of anesthetic practice such as trauma management, pain management, obstetric anesthesia, and pediatric anesthesia. Together, these subspecialty areas make up a large proportion of the clinical workload in LMICs. In these countries, the quality of education may be variable, there may be few teachers, and opportunities for continued learning and mentorship are rare. Short subspecialty courses such as Primary Trauma Care, Essential Pain Management, Safer Anaesthesia From Education-Obstetric Anaesthesia, and Safer Anaesthesia From Education-Paediatric Anaesthesia have been developed to help fill this need. They have the potential for immediate impact by providing an opportunity for continuing professional development and relevant subspecialty training. These courses are all short (1-3 days), are presented as an off-the-shelf package, and include a teach-the-teacher component. They use a variety of interactive teaching techniques and are designed to be adaptable and responsive to local needs. There is an emphasis on local ownership of the educational process that helps to promote sustainability. After an initial financial outlay to purchase equipment, the costs are relatively low. Short subspecialty courses appear to be part of the educational answer in LMICs, but there is a need for research to validate their role.