Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study.

OBJECTIVE: To examine the association of anesthesiologist sex on postoperative outcomes. BACKGROUND: Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown. METHODS: We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations. RESULTS: Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00-1.05, P =0.048). CONCLUSIONS: We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study.

The influence of resident and faculty gender on assessments in anesthesia competency-based medical education.

PURPOSE: Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system. METHODS: This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored. RESULTS: In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender. CONCLUSION: We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.

RéSUMé: OBJECTIF: La formation médicale fondée sur les compétences (FMFC) repose sur des évaluations fréquentes des stagiaires en milieu de travail, ce qui donne l'occasion de refléter les préjugés conscients et implicites dans ces évaluations. Notre objectif était d'examiner l'influence du genre des résident·es et des professeur·es sur les évaluations de la performance des résident·es au sein d'un système de FMFC. MéTHODE: Cette étude de cohorte rétrospective s'est déroulée d'août 2017 à janvier 2021 à l'aide des données d'évaluation des résident·es provenant de deux évaluations en milieu de travail : L'évaluation de l'anesthésie clinique par événement (ACEA ­ Anesthesia Clinical Encounter Assessment) et les Actes professionnels non supervisés (APNS). Des données autodéclarées sur le genre ont également été extraites. Le critère d'évaluation principal, soit les différences fondées sur le genre dans les cotes de confiance des résident·es sur l'ACEA et les APNS, a été évalué à l'aide d'une régression logistique à effets mixtes, les différences étant rapportées par les rapports de cotes et les intervalles de confiance (α = 0,01). Les différences fondées sur le genre dans la réception des commentaires en texte libre sur l'ACEA et les APNS ont également été explorées. RéSULTATS: Au total, 14 376 évaluations ACEA et 4467 évaluations APNS ont été analysées. Il n'y avait pas de différences significatives dans les cotes de confiance obtenues avec l'un ou l'autre des outils d'évaluation entre les résidents et les résidentes. Indépendamment du genre de la personne réalisant l'évaluation, les taux de confiance entre les résidentes et les résidents n'étaient pas significativement différents pour toutes les années de formation postdoctorale. De plus, les résident·es ont reçu des commentaires liés à leurs forces et leurs actes sur les deux évaluations à des fréquences comparables, quel que soit le genre du corps professoral. CONCLUSION: Nous n'avons constaté aucune différence fondée sur le genre dans les cotes de confiance telles qu'évaluées par les ACEA et les APNS, ce qui suggère une absence de préjugés genrés envers les résident·es au sein de ce système de FMFC. Compte tenu de l'hétérogénéité considérable en matière de clémence des évaluateurs et évaluatrices, les travaux futurs seraient plus fiables s'ils utilisaient des scores ajustés en fonction de ladite clémence plutôt que des scores bruts.

Validity evidence for the Anesthesia Clinical Encounter Assessment (ACEA) tool to support competency-based medical education.

BACKGROUND: Workplace-based assessment (WBA) is key to a competency-based assessment strategy. Concomitantly with our programme's launch of competency-based medical education, we developed an entrustment-based WBA, the Anesthesia Clinical Encounter Assessment (ACEA), to assess readiness for independent practice of competencies essential to perioperative patient care. This study aimed to examine validity evidence of the ACEA during postgraduate anaesthesiology training. METHODS: The ACEA comprises an eight-item global rating scale (GRS), an overall independence rating, an eight-item checklist, and case details. ACEA data were extracted for University of Toronto anaesthesia residents from July 2017 to January 2020 from the programme's online assessment portal. Validity evidence was generated following Messick's validity framework, including response process, internal structure, relations with other variables, and consequences. RESULTS: We analysed 8664 assessments for 137 residents completed by 342 assessors. From generalisability analysis, 10 independent observations (two assessments each from five assessors) were sufficient to achieve a reliability threshold of ≥0.70 for in-training assessments. A composite GRS score of 3.65/5 provided optimal sensitivity (93.6%) and specificity (90.8%) for determining entrustment on receiver operator characteristic curve analysis. Test-retest reliability was high (intraclass correlation coefficient [ICC2,1]=0.81) for matched assessments within 14 days of each other. Composite GRS scores differed significantly between residents based on their training level (P<0.0001) and correlated highly with overall independence (0.91, P<0.001). The internal consistency of the GRS (α=0.96) was excellent. CONCLUSIONS: This study supports the validity of the ACEA for assessing the competence of residents performing perioperative care and supports its use in competency-based anaesthesiology training.

Competency-based medical education: don't wait for change, lead it! / Educación médica basada en competencias: ¡No espere a que se produzca el cambio, lidérelo!

Competency-based medical education (CBME) is being implemented in many countries across the world. Medical bodies, such as the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Accreditation Council for Graduate Medical Education (ACGME) in the United States, are championing the 21st century mod ernization of the medical education system. Many Canadian medical educators asked, and my colleagues at the University of Toronto, continue to ask: in a country that already produces highly educated and seemingly competent physicians, why is there a need for change?

La formación médica basada en las competencias (CBME) se está implantando en muchos países del mundo. Los organismos médicos, como el Real Colegio de Médicos y Cirujanos de Canadá (RCPSC) y el Consejo de Acreditación para la Educación Médica de Postgrado (ACGME) en Estados Unidos, están defendiendo la modernización del sistema de educación médica del siglo XXI. Muchos educadores médicos canadienses se preguntan, al igual que mis colegas de la Universidad de Toronto, lo siguiente: en un país que ya produce médicos altamente formados y aparentemente competentes, ¿por qué es necesario un cambio?