Use of Simulation-Based Mastery Learning Curriculum to Improve Difficult Conversation Skills Among Anesthesiologists: A Pilot Study.

Background: Breaking bad news (BBN) is an important clinical task for physicians. Unfortunately, there is no standard method to teach and assess these skills of anesthesiologists. Although anesthesiology has become a relatively safe medical specialty, complications still occur that require disclosure to patients and their families. Disclosure of bad news can be a significant source of stress for clinicians, especially for those who have low confidence in their BBN skills. Anesthesiologists' skills in BBN can be improved with simulation-based mastery learning (SBML), an intense form of competency-based learning. Methods: An SBML curriculum was developed using the SPIKES (Situation, Perception, Invitation, Knowledge, Emotion, Summarize) framework for BBN and the NURSE (Naming, Understanding, Respecting, Supporting, Exploring) statements for expressing empathy. A pretest-posttest study was conducted from March 2020 to June 2022 to evaluate anesthesiologists' performance in BBN. Participants completed a 2-hour curriculum consisting of a pretest, didactic session, deliberate practice with feedback, and a posttest. Anesthesiologists were assessed using a 16-item skills checklist. Results: Six anesthesiology attendings and 14 anesthesiology fellows were enrolled in the study. Three of 20 participants met the minimum passing score (MPS) at the time of their pretest. All study participants met the MPS on their first posttest (P < .001). The median participant confidence in BBN significantly increased (3 to 4, P < .001). Overall course satisfaction in the curriculum was high, with a median score of 5. Conclusions: Our study demonstrates that a BBN SBML curriculum for anesthesiologists significantly improved communication skills and confidence in a simulated environment. Because only 3 participants met the MPS before training, our results suggest that anesthesiologists could benefit from further education to gain effective communication skills and that SBML training may be effective to achieve this result.

Recognition of novelty in leopard geckos (Eublepharis macularius) and tiger salamanders (Ambystoma tigrinum).

Novelty recognition helps organisms identify changes over time. Studies to date have usually involved mammals, particularly rodents. We explored leopard geckos' (Eublepharis macularius; Experiment 1) and tiger salamanders' (Ambystoma tigrinum, Experiment 2) sensitivity to spatial and object novelty. We used an exploratory paradigm adapted from rodents where time spent near objects in an open-field box was compared. Subjects first habituated to three objects. To evaluate spatial novelty recognition, one object was moved to a new location. Subjects again habituated to the objects' locations. To evaluate object novelty recognition, one object that had not been moved earlier was replaced with an unfamiliar object. Results indicated when one object was moved to a new location, geckos and salamanders spent more time near that spatially-displaced object. Additionally, when a familiar object was replaced with a new object, geckos and salamanders spent more time near the substituted object. These results suggest geckos and salamanders recognized changes in objects' identities and locations. Geckos and salamanders acted differentially depending on familiarity in both spatial and object domains. These results support attempts to include lesser-studied species in our efforts to characterize cognition.

Updates on neurologic complications in pediatric regional anesthesia.

Regional anesthesia has grown in popularity as a multimodal approach to analgesia. However, some anesthesiologists are fearful of regional blocks in pediatric patients as most require general anesthesia. One of the most alarming complications is neurologic injury. While there are limited case reports regarding the devastating neurologic injuries in pediatric patients, review of large databases has shown a level of safety in pediatric regional anesthesia that is comparable to that in adult patients. This review aimed to provide an update on the relevant literature regarding neurologic complications and the safety of regional blocks in pediatric patients. These large data sets have confirmed that regional anesthesia is a useful and safe modality in pediatric patients.

Placement of a Supraglottic Airway to Overcome Airway Obstruction When Performing Nasal Fiberoptic Intubation in Infants With Pierre Robin Sequence: A Case Series.

Patients with Pierre Robin sequence present with numerous anatomical abnormalities that make mask ventilation and tracheal intubation challenging. In this case series, we describe a unique way to overcome upper airway obstruction with the placement of a supraglottic airway in 4 children with Pierre Robin sequence followed by flexible bronchoscopic nasotracheal intubation. This new approach is proven to be a successful method to overcome severe upper airway obstruction, provide continuous oxygenation, and allows nasotracheal intubation for intraoral procedures.

Tiger salamanders' (Ambystoma tigrinum) use of features.

In their environment, salamanders must avoid both predation and desiccation, necessitating efficient movement throughout their world. Although past research has indicated that salamanders can use visual cues in navigating through their environment, it is not clear how geometric and feature information are incorporated by salamanders in their movement through their surroundings. Past work with a variety of species indicates that geometric information is regularly used and that features are also used under some circumstances. We explored salamanders' use of features when both had been available during initial learning. First, salamanders learned to navigate to a correct corner within a rectangular box with a distinctive column in each corner. Each salamander was assigned a correct corner, and salamanders were trained in acquisition to move toward the correct corner. Following acquisition, salamanders completed two test trials. In one, only geometric cues were available as the features were removed. In the second, the features' placements were jumbled and conflicted with the geometric information. These results suggest that salamanders in this experiment used feature information over geometric information when both had been previously available during acquisition.