RESUMEN
ABSTRACT: A central goal of precision education (PE) is efficiently delivering the right educational intervention to the right learner at the right time. This can be achieved through a PE cycle that involves gathering inputs, using analytics to generate insights, planning and implementing interventions, learning and assessing outcomes, and then using lessons learned to inform modifications to the cycle. In this paper, the authors describe 3 PE initiatives utilizing this cycle. The Graduate Medical Education Laboratory (GEL) uses longitudinal data on graduate trainee behavior, clinical skills, and wellness to improve clinical performance and professional fulfillment. The Transition to Residency Advantage (TRA) program uses learner data from medical school coupled with individualized coaching to improve the transition to residency. The Anesthesia Research Group for Educational Technology (TARGET) is developing an automated tool to deliver individualized education to anesthesia residents based on a longitudinal digital representation of the learner. The authors discuss strengths of the PE cycle and transferrable learnings for future PE innovations. Common challenges are identified, including related to data (e.g., volume, variety, sharing across institutions, using the electronic health record), analytics (e.g., validating augmented intelligence models), and interventions (e.g., scaling up learner assessments with limited resources). PE developers need to share their experiences in order to overcome these challenges, develop best practices, and ensure ethical development of future systems. Adapting a common framework to develop and assess PE initiatives will lead to a clearer understanding of their impact, help to mitigate potential risks, and allow deployment of successful practices on a larger scale.
Asunto(s)
Internado y Residencia , Tutoría , Humanos , Educación de Postgrado en MedicinaRESUMEN
Focused Assessment with Sonography in Trauma (FAST) examinations have been performed for decades by surgeons during initial patient presentation for emergency care and surgical planning, as well as for guiding resuscitation. This case highlights how use of intraoperative FAST examinations performed by anesthesiologists can dramatically change patient management. Use by anesthesiologists perioperatively is an important skill, although it is not widely practiced.
Asunto(s)
Servicios Médicos de Urgencia , Evaluación Enfocada con Ecografía para Trauma , Humanos , Anestesiólogos , Sistemas de Atención de Punto , UltrasonografíaRESUMEN
While transesophageal echocardiography (TEE) has traditionally been used in perioperative care, there is growing evidence supporting point of care ultrasound (POCUS) for the anesthesiologist in guiding patient care. It is a quick way to non-invasively evaluate hemodynamically unstable patients and ascertain their state of shock, determine volume status, and guide resuscitation in cardiac arrest. In addition, through use of POCUS, the anesthesiologist is able to identify signs of chronic heart disease to provide a more tailored and safer approach to perioperative care.
Asunto(s)
Anestesiología , Cardiopatías , Atención Perioperativa , Sistemas de Atención de Punto , Ultrasonografía , Humanos , Paro Cardíaco/diagnóstico por imagen , Paro Cardíaco/fisiopatología , Paro Cardíaco/terapia , Hemodinámica/fisiología , Ultrasonografía/métodos , Atención Perioperativa/métodos , Cardiopatías/diagnóstico por imagen , Cardiopatías/fisiopatología , Enfermedad Crónica , Volumen Sanguíneo , Choque/diagnóstico por imagen , Choque/fisiopatología , Anestesiología/métodosRESUMEN
Aortoatrial fistula formation is a rare complication of bacterial endocarditis. Fistulous tracts may form between the aorta and either atrium. Clinical presentation varies from an insignificant murmur to refractory congestive heart failure. Most clinically relevant fistula manifests with acute and severe symptoms. Transesophageal echocardiography (TEE) is more sensitive than transthoracic echocardiography (TTE) in diagnosing intracardiac shunts, and invaluable in guiding intraoperative surgical repair. Definitive therapy involves closure of the fistula either through an open surgical approach or percutaneously with an occluder device.
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Ecocardiografía Transesofágica/métodos , Endocarditis/complicaciones , Fístula/diagnóstico por imagen , Cardiopatías Congénitas/etiología , Aorta/patología , Femenino , Fístula/cirugía , Atrios Cardíacos/patología , Cardiopatías Congénitas/fisiopatología , Humanos , Persona de Mediana Edad , Dispositivo Oclusor Septal/efectos adversos , Resultado del TratamientoAsunto(s)
Manejo de la Vía Aérea/métodos , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/terapia , Cuerpos Extraños/complicaciones , Cuerpos Extraños/terapia , Anciano , Anestesia/métodos , Broncoscopía , Femenino , Tecnología de Fibra Óptica , Humanos , Intubación Intratraqueal , Traumatismos del Cuello/complicaciones , Traumatismos del Cuello/terapiaAsunto(s)
Cuidados Intraoperatorios/métodos , Complicaciones Intraoperatorias/diagnóstico por imagen , Alveolos Pulmonares/diagnóstico por imagen , Alveolos Pulmonares/fisiopatología , Ultrasonografía/métodos , Humanos , Hipoxia/complicaciones , Complicaciones Intraoperatorias/fisiopatología , Pulmón , Atelectasia Pulmonar/complicaciones , Atelectasia Pulmonar/diagnóstico por imagenRESUMEN
We present a case of a 41-year-old man who suffered cardiac arrest after induction of general anesthesia for an ambulatory ophthalmologic procedure. In this report, we highlight the use of focused transthoracic echocardiography by the anesthesia team to guide a prolonged resuscitation. Emergency room and critical care physicians have described the use of focused echocardiography to aid in diagnosing correctible causes of cardiac arrest, predicting outcomes, and in decision making regarding termination of resuscitation. We discuss benefits and barriers to anesthesiologists incorporating focused cardiac ultrasound into the perioperative arena.