Provider Education and Vaporizer Labeling Lead to Reduced Anesthetic Agent Purchasing With Cost Savings and Reduced Greenhouse Gas Emissions.

Anesthetic agents are known greenhouse gases with hundreds to thousands of times the global warming impact compared with carbon dioxide. We sought to mitigate the negative environmental and financial impacts of our practice in the perioperative setting through multidisciplinary staff engagement and provider education on flow rate reduction and volatile agent choice. These efforts led to a 64% per case reduction in carbon dioxide equivalent emissions (163 kg in Fiscal Year 2012, compared with 58 kg in Fiscal Year 2015), as well as a cost savings estimate of $25,000 per month.

An Intervention to Improve Medical Student Perception of Observation and Feedback During an Anesthesiology Clerkship.

BACKGROUND: Between 2011 and 2013, medical students at a large, tertiary academic hospital reported a lower-than-expected perception of direct observation and feedback during their third- and fourth-year clinical clerkships. The anesthesiology clerkship is a team-based care model that involves an anesthesiologist, resident or anesthetist, and student. This model allows for direct supervision of all patient interactions and procedures. Despite this structure, medical students reported an acceptable but lower-than-anticipated perception of direct observation and feedback taking place during a 2-week anesthesiology clerkship. METHODS: Interventions were proposed to improve student awareness of the supervision, teaching, and feedback taking place. A skills checklist for intravenous (IV) line placement that an anesthesia provider completed while observing the student was chosen as a meaningful intervention to improve the students' perception of observation and feedback. This checklist required direct observation of the IV line placement clinical skill, and the evaluator was directed to give oral feedback to the student. Students were surveyed regarding their perceptions of direct observation and feedback during a 4-year period, 2 years prior to and 2 years after implementation of the IV checklist. RESULTS: No statistically significant difference was noted between the preintervention and postintervention groups. CONCLUSION: While formal observation of and feedback on an IV placement did not change student perception, the intervention showed that a more in-depth analysis of the "educational alliance" desired during an anesthesiology clerkship is warranted, especially as medical education continues to evolve.