Predictive Validity of Anesthesiologists' Quality of Clinical Supervision and Nurse Anesthetists' Work Habits Assessed by Their Associations With Operating Room Times.

BACKGROUND: At all Joint Commission-accredited hospitals, the anesthesia department chair must report quantitative assessments of anesthesiologists' and nurse anesthetists' (CRNAs') clinical performance at least annually. Most metrics lack evidence of usefulness, cost-effectiveness, reliability, or validity. Earlier studies showed that anesthesiologists' clinical supervision quality and CRNAs' work habits have content, convergent, discriminant, and construct validity. We evaluated predictive validity by testing for (expected) small but statistically significant associations between higher quality of supervision (work habits) and reduced probabilities of cases taking longer than estimated. METHODS: Supervision quality of each anesthesiologist was evaluated daily by assigned trainees using the 9-item de Oliveira Filho scale. The work habits of each CRNA were evaluated daily by assigned anesthesiologists using a 6-item scale. Both are scored binary, 1 if all items are rated the maximum, 0 otherwise. From 40,718 supervision evaluations and 53,722 work habit evaluations over 8 fiscal years, 16 mixed-effects logistic regression models were estimated, with raters as fixed effects and ratees (anesthesiologists or CRNAs) as random effects. Empirical Bayes means in the logit scale were obtained for 561 anesthesiologist-years and 605 CRNA-years. The binary-dependent variable was whether the case took longer than estimated from the historical mean time for combinations of scheduled procedures and surgeons. From 264,060 cases, 8 mixed-effects logistic regression models were fitted, 1 per fiscal year, using ratees as random effects. Predictive validity was tested by pairing the 8 one-year analyses of clinical supervision, and the 8 one-year analyses of work habits, by ratee, with the 8 one-year analyses of whether OR time was longer than estimated. Bivariate errors in variable linear least squares linear regressions minimized total variances. RESULTS: Among anesthesiologists, 8.2% (46/561) had below-average supervision quality, and 17.7% (99/561), above-average. Among CRNAs, 6.3% (38/605) had below-average work habits, and 10.9% (66/605) above-average. Increases in the logits of the quality of clinical supervision were associated with decreases in the logits of the probabilities of cases taking longer than estimated, unitless slope = -0.0361 (SE, 0.0053), P < .00001. Increases in the logits of CRNAs' work habits were associated with decreases in the logits of probabilities of cases taking longer than estimated, slope = -0.0238 (SE, 0.0054), P < .00001. CONCLUSIONS: Predictive validity was confirmed, providing further evidence for using supervision and work habits scales for ongoing professional practice evaluations. Specifically, OR times were briefer when anesthesiologists supervised residents more closely, and when CRNAs had better work habits.

Critical Appraisal of Anesthesiology Educational Research for 2020.

Background: This study reviews and appraises the articles published about anesthesiology education in 2020. The objective is to highlight high-quality evidence while showcasing articles with innovative ideas and high relevance to the practices of the anesthesiology education community. Methods: Three Ovid MEDLINE databases, Embase.com, ERIC, PsycINFO, and PubMed were searched, followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double screened, and quantitative articles were subsequently scored by 3 randomly assigned raters. Qualitative studies were scored by 2 raters. Two different rubrics were used for scoring quantitative and qualitative studies. In addition, reviewers rated each article on its overall quality to create an additional list of top articles based solely on the opinion of the reviewers. Results: A total of 2,491 citations were identified through the search criteria and the manual review. Of those, 61 articles met the inclusion criteria (57 quantitative and 4 qualitative). The top 12 quantitative papers and the top qualitative papers with the highest scores are reported and summarized. Conclusions: We found that teaching clinical procedures continues to be a topic of interest, with more studies of improved rigor identified. New trends in wellness studies and increasing attention to distance learning and technology-assisted instructional methods were additional topics covered over the year.

Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway.

BACKGROUND: Video laryngoscopy may be useful in the setting of the difficult airway, but it remains unclear if intubation success is improved in routine difficult airway management. This study compared success rates for tracheal intubation with the C-MAC® video laryngoscope (Karl Storz, Tuttlingen, Germany) with conventional direct laryngoscopy in patients with predicted difficult airway. METHODS: We conducted a two arm, single-blinded randomized controlled trial that involved 300 patients. Inclusion required at least one of four predictors of difficult intubation. The primary outcome was successful tracheal intubation on first attempt. RESULTS: The use of video laryngoscopy resulted in more successful intubations on first attempt (138/149; 93%) as compared with direct laryngoscopy (124/147; 84%), P = 0.026. Cormack-Lehane laryngeal view was graded I or II in 139/149 of C-MAC attempts versus 119/147 in direct laryngoscopy attempts (P < 0.01). Laryngoscopy time averaged 46 s (95% CI, 40-51) for the C-MAC group and was shorter in the direct laryngoscopy group, 33 s (95% CI, 29-36), P < 0.001. The use of a gum-elastic bougie and/or external laryngeal manipulation were required less often in the C-MAC intubations (24%, 33/138) compared with direct laryngoscopy (37%, 46/124, P = 0.020). The incidence of complications was not significantly different between the C-MAC (20%, 27/138) versus direct laryngoscopy (13%, 16/124, P = 0.146). CONCLUSION: A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.

Critical Appraisal of Anesthesiology Educational Research for 2019.

Background: This study reviews and appraises the articles published about anesthesiology education in 2019. Through this critical appraisal, those interested in anesthesiology education are able to quickly review literature published during this year and explore innovative ways to improve education for all those involved in the practice of anesthesiology. Methods: Three Ovid MEDLINE databases, Embase.com, ERIC, and PsycINFO were searched followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double-screened and quantitative articles were subsequently scored by 3 randomly assigned raters. Qualitative studies were scored by 2 raters. Two different rubrics were used for scoring quantitative and qualitative studies; both allowed for scores ranging from 1 to 25. In addition, reviewers rated each article on its overall quality to create an additional list of top articles based solely on the opinion of the reviewers. Results: A total of 2374 unique citations were identified through the search criteria and the manual review. Of those, 70 articles met the inclusion criteria (62 quantitative and 8 qualitative). The top 12 quantitative papers and the top 2 qualitative papers with the highest scores were reported and summarized.Conclusions: This critical appraisal continues to be a useful tool for those working in anesthesiology education by highlighting the best research articles published over the year. Highlighting trends in medical education research in anesthesiology can help those in the field to think critically about the direction of this type of research.

Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions.

INTRODUCTION: The Glidescope video laryngoscope has been shown to be a useful tool to improve laryngeal view. However, its role in the daily routine of airway management remains poorly characterized. METHODS: This investigation evaluated the use of the Glidescope at two academic medical centers. Electronic records from 71,570 intubations were reviewed, and 2,004 cases were identified where the Glidescope was used for airway management. We analyzed the success rate of Glidescope intubation in various intubation scenarios. In addition, the incidence and character of complications associated with Glidescope use were recorded. Predictors of Glidescope intubation failure were determined using a logistic regression analysis. RESULTS: Overall success for Glidescope intubation was 97% (1,944 of 2,004). As a primary technique, success was 98% (1,712 of 1,755), whereas success in patients with predictors of difficult direct laryngoscopy was 96% (1,377 of 1,428). Success for Glidescope intubation after failed direct laryngoscopy was 94% (224 of 239). Complications were noticed in 1% (21 of 2,004) of patients and mostly involved minor soft tissue injuries, but major complications, such as dental, pharyngeal, tracheal, or laryngeal injury, occurred in 0.3% (6 of 2,004) of patients. The strongest predictor of Glidescope failure was altered neck anatomy with presence of a surgical scar, radiation changes, or mass. CONCLUSION: These data demonstrate a high success rate of Glidescope intubation in both primary airway management and rescue-failed direct laryngoscopy. However, Glidescope intubation is not always successful and certain predictors of failure can be identified. Providers should maintain their competency with alternate methods of intubation, especially for patients with neck pathology.

Crisis Management Simulation: The Value of Interdisciplinary Debriefing.

OBJECTIVE: Simulation offers an important avenue for surgical and anesthesia training. This is especially important for crisis management scenarios where individuals need to act quickly and efficiently for optimal patient care. Practice based performance can be measured and real time feedback provided during debriefing scenarios. METHODS: In this paper, we highlight a dual anesthesia and otolaryngology cavernous carotid injury scenario. The trials were run three different times with inter-trial debriefing. RESULTS: The focused debriefing improved resident performance in terms of blood loss on subsequent trials. Furthermore, the learners provided important feedback regarding the utility of training and how it improved their ability to handle crisis management scenarios in the future. CONCLUSION: Debriefing for crisis management in a simulation trial improves performance and trainee confidence. Follow up studies will evaluate real world effectiveness over a longer follow up period.

Establishing a Multidisciplinary Cavernous Carotid Injury Simulation to Train Neurosurgical, Otolaryngology, and Anesthesia Residents.

Carotid artery injuries are serious complications of endoscopic endonasal surgery. As these occur rarely, simulation training offers an avenue for technique and algorithm development in resident learners. This study develops a realistic cadaveric model for the training of crisis resource management in the setting of cavernous carotid artery injury. An expanded endonasal approach and right cavernous carotid injury is performed on a cadaveric head. The cadaver's right common carotid artery is cannulated and connected to a perfusion pump delivering pressurized simulated blood. A simulation mannequin is incorporated into the model to allow for vital sign feedback. Surgical and anesthesia resident learners are tasked with obtaining vascular control with a muscle patch technique and medical management over the course of 3 clinical scenarios with increasing complexity. Crisis management instructions for an endoscopic endonasal approach to the cavernous carotid artery and blood pressure control were provided to the learners prior to beginning the simulation. An independent reviewer evaluated the learners on communication skills, crisis management algorithms, and implementation of appropriate skill sets. After each scenario, residents were debriefed on how to improve technique based on evaluation scores in areas of situational awareness, decision-making, communications and teamwork, and leadership. After the simulation, learners provided feedback on the simulation and this data was used to improve future simulations. The benefit of this cadaveric model is ease of set-up, cost-effectiveness, and reproducibility.

Critical Appraisal of Anesthesiology Educational Research for 2018.

BACKGROUND: Through a critical appraisal of the education research in anesthesiology, this article enables those interested in the field to read the high-quality articles for the past year and possibly implement these evidence-based interventions and concepts into practice. This study reviews and appraises all medical education studies published in 2018 in anesthesiology and summarizes the highest-rated articles evaluated. METHODS: Three Ovid MEDLINE databases, Embase.com, ERIC, PsycINFO, and PubMed were searched followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double-screened and quantitative articles subsequently scored by 3 randomly assigned raters. Qualitative studies were scored by 2 raters. Two different rubrics were used for scoring quantitative and qualitative studies, both allowed for scores ranging from 1 to 25. RESULTS: A total of 888 unique citations were identified through the search criteria. Of those, 39 articles met the inclusion criteria (36 quantitative and 3 qualitative). The top 11 quantitative papers and the top qualitative paper with the highest scores were reported and summarized. CONCLUSIONS: As the second article to critically review the literature available for education in anesthesiology, we are able to add to this annual series to help further disseminate the articles of the highest quality in anesthesiology education. Because this is only the second year, we can only report on initial suggestions of trends that we hope will help guide future research.

Twelve Tips for Utilizing Residency Program Social Media Accounts for Modified Residency Recruitment.

This article was migrated. The article was marked as recommended. Social media use across the health professions has significantly expanded in recent years. Specific attention has been paid to both the value of social media use in graduate medical education with residency program twitter accounts. More recently, social media has been examined for its role in supporting the rapid expansion of information exchange and connection across digital and virtual platforms during the COVID-19 pandemic. With the ongoing response to the pandemic, the 2020-2021 residency application cycle is anticipated to be a completely virtual interview process. Here, we draw from our collective experiences managing, maturing, and maximizing social media accounts for residency programs and GME to provide practical tips for using social media for the upcoming virtual interview season.

Video laryngoscopy with the macintosh video laryngoscope in simulated prehospital scenarios by paramedic students.

OBJECTIVE: To investigate the effectiveness of the Karl Storz BERCI DCI Macintosh video laryngoscope (MVL) via the TELE PACK system for facilitating intubation by novice paramedic students in a simulation environment. We assessed the laryngeal view, measured by percentage of glottic opening (POGO), when intubating the SimMan manikin airway in different settings. The primary endpoint was the best POGO achieved by the student. Secondary endpoints included intubation times and success rate. METHOD: We enrolled 25 novice paramedic students to intubate SimMan manikins. Students were randomized to use either a conventional Macintosh 3 (Mac3) blade alone or the MVL with a Mac3 blade. Students attempted their first intubation with the manikin on a stretcher in a normal neck position and reattempted intubation with the manikin's neck stiffened. The groups then crossed over using the alternate device to repeat the attempts in the manikin with a normal neck and with a stiffened neck. The students then attempted the same sequence of four intubations with the manikin on the floor. RESULTS: The MVL significantly improved POGO in all scenarios (p < 0.05). The MVL improved mean POGO 16% +/- 6% in the manikin with a normal neck position on a stretcher and 33% +/- 7% in the manikin with a stiff neck on the floor. The improvement was significantly greater in simulated difficult scenarios. The intubation success rate (94%) was equal in the two groups, and the POGO was significantly worse in the failures. In some subgroups, intubation times were longer with the MVL. CONCLUSION: The MVL improves the laryngeal view for novice laryngoscopists in a simulated setting, and this improvement is greatest in simulated difficult scenarios.

Critical Appraisal of Anesthesiology Educational Research for 2017.

Background Critical appraisals provide a method for establishing the status of an area of study or evaluating the effectiveness of literature within it. The purpose of this study was to review and appraise studies published in 2017 on medical education in anesthesiology and to provide summaries of the highest-quality medical education research articles in the field. Methods Three Ovid MEDLINE databases, Embase.com, Education Resources Information Center (ERIC), and PsycINFO, were searched followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double-screened and quantitative articles subsequently scored by three randomly assigned raters. Qualitative studies were scored by two raters. Two different rubrics were used for scoring quantitative and qualitative studies, both allowed for scores ranging from 1-25. Results A total of 864 unique citations were identified through the search criteria. Of those, 62 articles met the inclusion criteria, with 59 quantitative and three qualitative. The top 10 papers with the highest scores were reported and summarized. Discussion As the first article to critically review the literature available for education in anesthesiology, we hope that this study will serve as the first manuscript in an annual series that will help individuals involved in anesthesiology education gain an understanding of the highest-quality research in the field. Once this process is repeated, trends can be tracked and serve as a resource to educators and researchers in anesthesiology for years to come.

Integrated Otolaryngology and Anesthesia Simulation Model for Crisis Management of Cavernous Carotid Artery Injury.

Simulation training is emerging as a cost-effective way to train residents on the skill sets necessary to excel as fully functioning physicians. Until recently, the simulated resident training environments have primarily focused on handling a medical crisis with learners from the same specialty. A dual otolaryngology and anesthesiology simulation was established to improve teamwork and communication skills between specialties. One otolaryngology resident was paired with one anesthesia resident per trial in our study. The multispecialty team addressed three clinical simulation scenarios to manage a cavernous carotid artery-bleeding crisis with an endoscopic endonasal approach. An independent reviewer evaluated each individual based on situation awareness, decision-making, communications and teamwork, as well as leadership. Residents improved on blood loss, pre and post anatomical exam scores, and communication measures through the course of the scenarios. Residents from both specialties rated the simulation highly and wanted further simulation training in the future. Multidisciplinary simulation training is a novel approach for improving communication skills between specialties prior to entering the wards, clinic, or operative arena. The lessons learned from this multidisciplinary simulation transcend the individual experience by allowing trainees to develop algorithms for crisis management and to improve on aspects of teamwork, leadership, and communication skills that can be applied throughout their careers.

Crisis Management Simulation: Establishing a Dual Neurosurgery and Anesthesia Training Experience.

BACKGROUND: Simulation training has been shown to be an effective teaching tool. Learner management of an intraoperative crisis such as a major cerebrovascular bleed requires effective teamwork, communication, and implementation of key skill sets at appropriate time points. This study establishes a first of a kind simulation experience in a neurosurgery/anesthesia resident (learners) team working together to manage an intraoperative crisis. METHODS: Using a cadaveric cavernous carotid injury perfusion model, 7 neurosurgery and 6 anesthesia learners, were trained on appropriate vascular injury management using an endonasal endoscopic technique. Learners were evaluated on communication skills, crisis management algorithms, and implementation of appropriate skill sets at the right time. A preanatomic and postanatomic examination and postsimulation survey was administered to neurosurgery learners. Anesthesia learners provided posttraining evaluation through a tailored realism and teaching survey. RESULTS: Neurosurgery learners' anatomic examination score improved from presimulation (33.89%) to postsimulation (86.11%). No significant difference between learner specialties was observed for situation awareness, decision making, communications and teamwork, or leadership evaluations. Learners reported the simulation realistic, beneficial, and highly instructive. CONCLUSIONS: Realistic, first of kind, clinical simulation scenarios were presented to a neurosurgery/anesthesia resident team who worked together to manage an intraoperative crisis. Learners were effectively trained on crisis management, the importance of communication, and how to develop algorithms for future implementation in difficult scenarios. Learners were highly satisfied with the simulation training experience and requested that it be integrated more consistently into their residency training programs.

Assessing the Academic Productivity of Foundation for Anesthesia Education and Research (FAER) Resident Scholars.

BACKGROUND: The Foundation for Anesthesia Education and Research Resident Scholar Program (RSP) supports academically promising anesthesiology residents to attend mentoring seminars at the American Society of Anesthesiologists annual meeting. The objective of this study was to describe the career paths of RSP participants. METHODS: Prior RSP participants were surveyed regarding their academic productivity and their evaluation of the RSP experience. Univariate statistics were used to characterize the survey results. RESULTS: A total of 882 RSP participants were surveyed. The response rate was 26%. Seventy-two percent of respondents had worked in an academic institution, and 45% (95% CI: 38%-51%) were currently at an academic institution, which is higher than the national average of 18% (P<0.001). CONCLUSIONS: This program may be a model for supporting the development of future academic anesthesiologists.

Perceived predictive value of the Medical Student Performance Evaluation (MSPE) in anesthesiology resident selection.

STUDY OBJECTIVE: To study the perceptions of anesthesiology resident program directors about the value of the Medical Student Performance Evaluation (MSPE) in predicting successful residents. DESIGN: Survey instrument. SETTING: Anesthesiology department of a university hospital. MEASUREMENTS: An online survey was sent to 115 U.S. medical school-based anesthesiology residency program directors. Descriptive statistics were used to report which sections of the MSPE were predictive and which were not predictive. More than 30 qualitative comments were hand-coded for frequency and emerging themes. MAIN RESULTS: Those sections predictive of success included the (a) academic history summary, (b) academic progress, (c) academic ranking, and (d) the candidate's comparative clinical performance. Non-predictive sections included (a) unique characteristics, (b) pre-clinical comparative performance, (c) professional behaviors versus those of classmates, (d) summary statement, and (e) Appendix E. The strongest theme emerging from the qualitative findings was a desire for the MSPE to indicate candidates' rank. CONCLUSIONS: Anesthesiology programs tend to rely on the most objective sections of the MSPE. While program directors valued comments from clinical faculty, they did not hold the preclinical performance relative to peers in similar esteem, and there is a lack of reliability in the MSPE's assessment of professional behaviors.

Statewide simulation systems: the next step for anesthesiology?

Statewide simulation networks afford not only the possibility of meeting capacity needs for anesthesiologists, but also provide a venue for training trainers, setting standards, and bringing academic and nonacademic practices together. Furthermore, a statewide network that is appropriately designed opens the door to interdisciplinary activity. Oregon is the first state to implement simulation education across disciplines throughout the state. The model provides an example of how simulation can be successfully applied across a large and diverse area. The article details the benefits of statewide simulation networks, discusses challenges to implementing such networks, and describes Oregon's statewide efforts.

Mannequin-based simulation to reinforce pharmacology concepts.

Simulation education provides many new learning opportunities to healthcare training. This article delineates a method that utilizes a variety of teaching methods that include structured lecture-based education, active simulation-based education, and reflective inquiry. A course in pharmacology is used as an example to show how these different methods can be employed to offer students an immersive experience that reinforces traditional lecture-based learning. The paper is presented in such a way that it is easily applied to multiple situations and includes schematics, evaluation data, and equipment lists. Evaluation data strongly supported the continued use of this methodology.