Predictors of getting a residency interview: Differences by medical specialty.

OBJECTIVES: Gaining medical residency interviews has become more competitive and costly for medical students. Although limited evidence from residency programme directors indicates predictors for successfully matching into a programme, past research has not sufficiently explored the application components necessary to receive an interview offer. The present study will identify which application components are most helpful in obtaining interview offers for different medical specialties. METHODS: Data were sourced from the Texas Seeking Transparency in Application to Residency (STAR), a survey of recently matched fourth-year American medical students who self-reported information on their residency application components and interview offers. Multi-level logistic regression analyses were employed to predict the odds of interview offer according to applicants' academic, research and extracurricular characteristics. Sub-analyses were conducted for each medical specialty. RESULTS: Nearly 10 000 students reported information on over 419 010 applications submitted, which resulted in 164 696 interview offers. Across the sample, applicants had greater odds of receiving an interview offer if they had a geographic connection to the programme (odds ratio [OR] = 4.10, 95% confidence interval [CI] 4.00-4.20), had completed an away rotation at the programme (OR = 16.00, 95% CI 14.92-17.15), were Alpha Omega Alpha Honor Medical Society members (OR = 1.49, 95% CI 1.36-1.64), or had been inducted into the Gold Humanism Honor Society (OR = 1.50, 95% CI 1.39-1.62). Applicants had reduced odds of getting an interview if they had been required to remediate a course in medical school (OR = 0.73, 95% CI 0.64-0.83) or had failed the US Medical Licensing Examination Step 1 or Step 2 examination on their first attempt (OR = 0.40, 95% CI 0.33-0.47). Predictors of obtaining an interview varied by specialty. CONCLUSIONS: The present findings can assist senior medical students as they prepare residency applications and identify programmes to which they will apply. Knowledge of the significant factors can help applicants more efficiently use resources to maximise their number of interview offers. Completing away rotations and selecting programmes with which applicants have geographic connections may increase their odds of receiving interview offers.

Relationship Between Emotional Intelligence and Clinical Performance in Student Registered Nurse Anesthetists.

ABSTRACT: Emotional intelligence (EI) includes skills such as recognizing, understanding, and managing emotions. This pilot study investigated the utility of the Mayer-Salovey-Caruso Emotional Intelligence Test Version 2.0 as a screening instrument in student registered nurse anesthetists by determining if EI predicted clinical performance. Scores from 11 participants enrolled in a single nurse anesthesia program were correlated with formative clinical evaluations. Relationships between EI and clinical performance were examined. Participants consistently met clinical performance objectives but were unable to use emotion to solve problems or to recognize others' emotions, suggesting that EI abilities could impact future student registered nurse anesthetist clinical performance.

School health class associated with reduced odds of eating disorder symptoms in American adolescents.

OBJECTIVE: Eating disorder symptoms, including eating disorder diagnosis, binge eating, and unhealthy weight loss, are associated with health risks, and adolescence may be an optimal time to provide education on healthy alternatives. This research explored whether in-school health information during adolescence is associated with eating disorder symptoms in young adulthood. METHOD: Data were used from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of American youth, including information from Wave I, when participants were in Grades 7-12, and from Wave III, when participants were aged 18-26. Logistic regression analyses predicted eating disorder symptoms from in-school health information, adjusting for demographic and educational covariates. In-school health information and eating disorder symptoms were based on participant self-report. RESULTS: In-school health information about both diet (the foods you should and should not eat) and the importance of exercise compared to no health information reduced the odds of youth-reported eating disorder history odds ratio ((OR) = 0.23, 95% CI = 0.11-0.48). Individuals who received information on exercise alone compared to no health information were also less likely to use weight pills to control weight (OR = 0.26, 95% CI = 0.11-0.61). There was no difference in binge-eating symptoms based on school health class. DISCUSSION: Findings from this exploratory research study indicate that in-school receipt of information on diet and exercise has modest associations with eating disorder symptoms, including lower odds of a self-reported eating disorder and lower odds of using weight loss pills. Further research is needed to definitely test the role of school health class on eating disorder symptoms.

Content validity testing of questions for a patient satisfaction with general anesthesia care instrument.

INTRODUCTION: Patient satisfaction with any health care experience is the result of a complex set of interactions between the patient and the health system in which care is received. Measuring patient satisfaction allows quantification of the congruence between the expectations of care and the care that is received. It is important to quantify satisfaction with care because it involves the patient in the care experience and decreases the potential gap between expected and actual care delivered over time. Despite the benefits of measuring satisfaction with anesthesia care, this outcome has been historically understudied possibly because of a lack of reliable tools that measure the construct. PURPOSE: The purpose of this study was to test the content validity of items derived from an integrated review of studies that measured patient satisfaction with anesthesia care. METHODS: The content validity of the questions was tested using an expert panel. A total of 13 nurse anesthetists consented to participate in the study as expert panel members. Each expert panel member evaluated the items for content validity on a 4-point scale. Both an Individual Content Validity Index (I-CVI) and a Scale Content Validity Index (S-CVI) were calculated. RESULTS: All I-CVI scores were greater than 0.8. The range of I-CVI was 0.833 to 1.0. The average scale Content Validity Index (S-CVI/ave) was 0.979. CONCLUSION: High content validity of all items was supported by an expert panel of anesthesia providers. The high level of agreement among raters related to the content of the general anesthesia statements supports progressing to the next step in instrument development.

Use of the Rasch model for initial testing of fit statistics and rating scale diagnosis for a general anesthesia satisfaction questionnaire.

BACKGROUND AND PURPOSE: The level of patient satisfaction is a result of a complex set of interactions between the patient and the health care provider. It is important to quantify satisfaction with care because it involves the patient in the care experience and decreases the potential gap between expected and actual care delivered. METHODS: We tested a preliminary 23-item instrument to measure patient satisfaction with general anesthesia care. The rating scale Rasch model was chosen as the framework. RESULTS: There were 10 items found to have sufficient evidence of stable fit statistics. Items included 2 questions related to information provided, 2 questions related to concern and kindness of the provider, and 1 question each for interpersonal skills of the provider, attention by the provider, feeling safe, well-being, privacy, and overall anesthesia satisfaction. CONCLUSION: Such actions as providing enough time to understand the anesthesia plan, answering questions related to the anesthetic, showing kindness and concern for the patient, displaying good interpersonal skills, providing adequate attention to the patient, providing a safe environment that maintains privacy and provides a sense of well-being are important actions that are well within the control of individual anesthesia providers and may lead to improved care from the perception of the patient.

Enhancing Intraoperative Cholangiography Interpretation Skills: A Perceptual Learning Approach for Surgical Residents.

OBJECTIVE: Laparoscopic cholecystectomy is a commonly performed surgery with risk of serious complications. Intraoperative cholangiography (IOC) can mitigate these risks by clarifying the anatomy of the biliary tree and detecting common bile duct injuries. However, mastering IOC interpretation is largely through experience, and studies have shown that even expert surgeons often struggle with this skill. Since no formal curriculum exists for surgical residents to learn IOC interpretation, we developed a perceptual learning (PL)-based training module aimed at improving surgical residents' IOC interpretation skills. DESIGN: Surgical residents were assessed on their ability to identify IOC characteristics and provide clinical recommendations using an online training module based on PL principles. This research had 2 phases. The first phase involved pre/post assessments of residents trained via the online IOC interpretation module, measuring their IOC image recognition and clinical management accuracy (percentage of correct responses), response time and confidence. During the second phase, we explored the impact of combining simulator-based IOC training with the online interpretation module on same measures as used in the first phase (accuracy, response time, and confidence). SETTING: The study was conducted at Rush University Medical College in Chicago. The participants consisted of surgical residents from each postgraduate year (PGY). Residents participated in this study during their scheduled monthly rotation through Rush's surgical simulation center. RESULTS: Total 23 surgical residents participated in the first phase. A majority (95.7%) found the module helpful. Residents significantly increased confidence levels in various aspects of IOC interpretation, such as identifying complete IOCs and detecting abnormal findings. Their accuracy in making clinical management decisions significantly improved from pretraining (mean accuracy 68.1 +/- 17.3%) to post-training (mean accuracy 82.3 +/- 10.4%, p < 0.001). Furthermore, their response time per question decreased significantly from 25 +/- 12 seconds to 17 +/- 12 seconds (p < 0.001). In the second phase, we combined procedural simulator training with the online interpretation module. The 20, first year residents participated and 88% found the training helpful. The training group exhibited significant confidence improvements compared to the control group in various aspects of IOC interpretation with observed nonsignificant accuracy improvements related to clinical management questions. Both groups demonstrated reduced response times, with the training group showing a more substantial, though nonsignificant, reduction. CONCLUSION: This study demonstrated the effectiveness of a PL-based training module for improving aspects of surgical residents' IOC interpretation skills. The module, found helpful by a majority of participants, led to significant enhancements in clinical management accuracy, confidence levels, and decreased response time. Incorporating simulator-based training further reinforced these improvements, highlighting the potential of our approach to address the lack of formal curriculum for IOC interpretation in surgical education.

Complex regional pain syndrome: a review of diagnostics, pathophysiologic mechanisms, and treatment implications for certified registered nurse anesthetists.

The pathophysiologic mechanisms for complex regional pain syndrome (CRPS) are complex and elusive. The proposed etiologic mechanisms for CRPS include inflammatory responses, peripheral or central sensitization, and sympathetic dysfunction. Anesthesia care of patients with CRPS is challenging. Treatments including physiotherapy, peripheral vasodilators, sympathetic blockade, analgesics, and other systemic medications can help optimize mobility, perfusion, and pain relief for affected patients.

AANA Journal Course Clarifying the Confusion of Adult Emergence Delirium.

To date, researchers studying emergence delirium in adults have not adopted a consensus on the terminology for the phenomenon, a formalized definition, a measurement tool or standardized differential diagnosis to distinguish emergence delirium from postoperative delirium, anticholinergic or serotonergic toxicities, and other physiologic issues that may present on emergence from anesthesia. This lack of a consensus in emergence delirium research and differential diagnostic tools is confounding findings and preventing improved patient outcomes. Information from an integrative review of the literature in conjunction with a Delphi study was used to develop a standardized differential of similarly presenting phenomena to assist clinicians in determining appropriate interventions for patients who appear to have emergence delirium.

Computer-Based Case Simulations for Assessment in Health Care: A Literature Review of Validity Evidence.

Simulation for education and training in health-care professions has been widely applied. However, its value as an assessment tool for competence is not fully known. Logistical barriers of simulation-based assessments have led some health-care organizations to utilize computer-based case simulations (CCSs) for assessment. This article provides a review of the literature on the identification of psychometrically sound, CCS instruments designed to measure decision-making competence in health-care professionals. CINAHL, MEDLINE, and Ovid databases identified 84 potentially relevant articles published between January 2000 and May 2017. A total of 12 articles met criteria for inclusion in this review. Findings of these 12 articles indicate that summative assessment in health care using CCSs in the form of clinical scenarios is utilized to assess higher order performance aspects of competence in the form of decision-making. Psychometric strength was validated in eight articles and supported by four replication studies. Two of the eight articles reported evidence of construct validity and support the need for evidence based on a theoretical framework. This literature review offers implications for further research on the use of CCS tools as a method for assessment of competence in health-care professionals and the need for psychometric evidence to support it.

Preventable Closed Claims in the AANA Foundation Closed Malpractice Claims Database.

Medical errors are among the top 3 causes of patient deaths in the United States, with up to 400,000 preventable deaths occurring in hospitalized patients each year. Although improvements have been made in anesthesia patient safety, adverse outcomes continue to occur. This study used thematic analysis to examine anesthesia closed claims that were associated with preventable morbidity and mortality. Investigators determined that 123 closed malpractice claims files from the American Association of Nurse Anesthetists (AANA) Foundation closed claims database involved events that the involved Certified Registered Nurse Anesthetist could have prevented. Factors that were associated with preventable closed claims included communication failures, violations of the AANA Standards for Nurse Anesthesia Practice, and errors in judgment.

The Perceived Value of Certification in Nonsurgical Pain Management.

Chronic pain is a growing epidemic in America. Challenges in patients' access to care, and in reimbursement to Certified Registered Nurse Anesthetists (CRNAs) who provide pain services, have resulted in a voluntary subspecialty certification in nonsurgical pain management (NSPM) for CRNAs. An evaluation was conducted of perceptions of CRNAs toward the value of certification in NSPM. An invitation to complete the Perceived Value of Certification Tool (PVCT) was sent to 474 CRNAs who identified the subspecialty practice of NSPM upon application for recertification to the NBCRNA. Data were collected on 18 factors related to the perceived value of certification in the NSPM subspecialty. Exploratory factor analysis using principal components analysis with varimax rotation was conducted to assess the latent structure of the PVCT and to identify potential constructs of CRNAs' perceptions. Reliability was assessed using Cronbach α coefficients. Of 64 CRNAs who provided data, a 3-factor solution emerged that explained 72.25% of the overall variance: personal satisfaction, professional recognition, and competence, each with excellent to good reliability (F1: α = 0.95, F2: α = 0.94, F3: α = 0.88). Identification of the 3 constructs in this study will assist with future efforts of examination validation for the subspecialty of NSPM certification for CRNAs.

Evidence-Based Use of Nonopioid Analgesics.

Analgesia is a necessary component of any anesthetic technique, and can be achieved with local anesthetics, opioid and nonopioid analgesics, and inhaled anesthetic agents. Risks and benefits are associated with each of the agents and techniques described here, including local anesthetic systemic toxicity, respiratory depression, nausea, and urinary retention. Implementation of Enhanced Recovery After Surgery (ERAS) protocols, use of preemptive analgesia techniques, and the national opioid crisis are fostering increased utilization of nonopioid analgesics, including local anesthetics, nonsteroidal anti-inflammatory medications, intravenous acetaminophen, neuromodulatory agents such as gabapentin, corticosteroids, centrally acting ⟨2 agonists, and ketamine. Certified Registered Nurse Anesthetists optimize the safety and quality of care they provide through use of evidence-based practice, including the drugs they select, order, and administer, such as opioid and nonopioid analgesics, when providing anesthesia care.

The perioperative implications of obstructive sleep apnea.

Patients with obstructive sleep apnea provide significant challenges to the perioperative team. This disorder is often undiagnosed and coexists with other disease processes such as hypertension, congestive heart failure, and cor pulmonale. The prevalence of obesity in American society suggests that an increasing number of patients with sleep apnea will present for surgery. During the perioperative period, life-threatening problems can occur during anesthetic induction and emergence. The pathophysiology of obstructive sleep apnea is reviewed here along with the anesthesia implications of this disease process. Members of the perioperative team need to be aware of the implications of sleep apnea so that surgical outcomes can be optimized.

Ludwig angina: forewarned is forearmed.

While the incidence of Ludwig angina is decreasing, this is an important disease process because failure to control the airway can have catastrophic consequences. Accurate diagnosis, airway control, antibiotic therapy, and, occasionally, surgical management are essential for patient safety. Ludwig angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by hardened induration of the floor and suprahyoid region bilaterally with an elevation of the tongue potentially obstructing the airway. In the preantibiotic era, Ludwig angina was frequently fatal; however, antibiotics and aggressive surgical treatment have significantly lowered mortality.

Collaborative practice in advanced practice nursing in acute care.

APN in the United States encompasses a variety of collaborative models of care. Collaborative relationships with other disciplines such as medicine, pharmacy, social service, and physical, respiratory, and occupational therapy are an important component of the APN role. The collaborative relationship of the APN and physician is a unique one for providing optimal patient and family care. As changes in healthcare in acute care settings continue to occur, additional collaborative models for APN and physician care will only continue to help in meeting the healthcare needs of patients.

AANA journal course. Update for nurse anesthetists. Parkinson disease.

In this Journal course, the manifestations, etiologic and pathophysiologic factors, and incidence of Parkinson disease are reviewed along with current medical management. Medications and other factors that have an impact on the course of Parkinson disease are discussed. Suggested preanesthetic, intraoperative, and postoperative interventions are provided.

A study of clinical decision making by certified registered nurse anesthetists.

Anesthesia outcomes and related risk factors have been studied for more than 100 years. Varying sample sizes and research methods have been used, with research findings that were open to multiple interpretations. Research with closed malpractice claims demonstrates that American Society of Anesthesiologists physical status II patients undergoing elective procedures are most likely to experience damaging events intraoperatively with resultant postoperative adverse outcomes. The process of care, including clinical decision making, contributes to adverse outcomes. Clinical decision making can be difficult to assess and measure. In this study, the cognitive psychology framework of information-processing theory and literature pertaining to the use of heuristics, or rules of thumb, and clinical biases, were used to analyze cases from the AANA Foundation closed malpractice claims database. This database contains more than 300 files involving St Paul Fire and Marine Insurance Company-covered CRNAs from across the United States. These files were analyzed by 10 CRNA investigators on the AANA Closed Claims research team. Variables such as inadequate preinduction activities, e.g., incomplete preanesthetic assessments, and use of cognitive biases and inaccurate probability estimation were associated with adverse outcomes in this research sample. Teaching of decision science in basic and continuing nurse anesthesia education is advocated.

Use of the Rasch Model for Initial Testing of Fit Statistics and Rating Scale Diagnosis for a General Anesthesia Satisfaction Questionnaire.

BACKGROUND AND PURPOSE: The level of patient satisfaction is a result of a complex set of interactions between the patient and the health care provider. It is important to quantify satisfaction with care because it involves the patient in the care experience and decreases the potential gap between expected and actual care delivered. METHODS: We tested a preliminary 23-item instrument to measure patient satisfaction with general anesthesia care. The rating scale Rasch model was chosen as the framework. RESULTS: There were 10 items found to have sufficient evidence of stable fit statistics. Items included 2 questions related to information provided, 2 questions related to concern and kindness of the provider, and 1 question each for interpersonal skills of the provider, attention by the provider, feeling safe, well-being, privacy, and overall anesthesia satisfaction. CONCLUSION: Such actions as providing enough time to understand the anesthesia plan, answering questions related to the anesthetic, showing kindness and concern for the patient, displaying good interpersonal skills, providing adequate attention to the patient, providing a safe environment that maintains privacy and provides a sense of well-being are important actions that are well within the control of individual anesthesia providers and may lead to improved care from the perception of the patient.