Four-dimensional (4D) printing has attracted significant attention, because it enables structures to be reconfigured based on an external stimulus, realizing complex architectures that are useful for different applications. Nevertheless, most previously reported 4D-printed components have focused on actuators, which are just one part of a full soft robotic system. In this study, toward achieving fully 4D-printed systems, the design and direct ink writing of sensors with a straining mechanism that mimics the 4D effect are explored. Solution-processable carbon nanotubes (CNTs) were used as the sensing medium, and the effect of a heat-shrinkable shape-memory polymer-based substrate (i.e., potential 4D effect) on the electronic and structural properties of CNTs was assessed, followed by their application in various sensing devices. Herein, we reveal that substrate shrinking affords a more porous yet more conductive film owing to the compressive strain experienced by CNTs, leading to an increase in the carrier concentration. Furthermore, it improves the sensitivity of the devices without the need for chemical functionalization. Interestingly, the results show that, by engineering the potential 4D effect, the selectivity of the sensor can be tuned. Finally, the sensors were integrated into a fully 4D-printed flower structure, exhibiting their potential for different soft robotic applications.
Understanding the patient's experience with COVID-19 was essential to providing high-quality, person-centered care during the pandemic. Having empathy or being able to understand and respond to the patient's experience may lead to improved outcomes for both patients and clinicians. There is mixed evidence about how best to teach empathy, particularly related to promoting empathy during COVID-19. Literature suggests that virtual reality may be effective in empathy-related education. In collaboration with four patient partners with lived experience, a 360° VR video was developed reflecting their stories and interactions with the healthcare system. The aim of this study was to pilot test the video with interprofessional healthcare providers (HPs) to explore acceptability and utility, while also seeking input on opportunities for improvement. Eleven HPs reviewed the video and participated in one of three focus groups. Focus group data were analyzed using thematic analysis. Data suggest that video content is acceptable and useful in promoting a better understanding of the patient's experience. Building on these encouraging findings, additional iterations of videos to promote empathy will be developed and tested.
Ultraviolet (UV) exposure overdose can cause health issues such as skin burns or other skin damage. In this work, a UV and temperature sensor smartwatch is developed, utilizing a multimaterial 3D printing approach via a vat photopolymerization-digital light processing technique. Photochromic (PC) pigments with different UV sensitivities, UVA (315-400 nm) and UVB (315-280 nm), were utilized to cover a wider range of UV exposure and were mixed in transparent resin, whereas the smartwatch was printed with controlled thickness gradients. A multifunctional sensor was next fabricated by adding a thermochromic (TC) material to PC, which is capable of sensing UV and temperature change. Colorimetric measurements assisted by a smartphone-based application provided instantaneous as well as cumulative UV exposure from sunlight. The mechanical properties of the device were also measured to determine its durability. The prototype of the wearable watch was prepared by fixing the 3D-printed dial to a commercially available silicon wristband suitable for all age groups. The 3D-printed watch is water-resistant and easily removable, allowing for its utilization in multiple outdoor activities. Thus, the developed wearable UV sensor alerts the user to the extent of their UV exposure, which can help protect them against overexposure.
Constant exposure to blue light emanating from screens, lamps, digital devices, or other artificial sources at night can suppress melatonin secretion, potentially compromising both sleep quality and overall health. Daytime exposure to elevated levels of blue light can also lead to permanent damage to the eyes. Here, we have developed blue light protective plasmonic contact lenses (PCLs) to mitigate blue light exposure. Crafted from poly(hydroxyethyl methacrylate) (pHEMA) and infused with silver nanoparticles, these contact lenses serve as a protective barrier to filter blue light. Leveraging the plasmonic properties of silver nanoparticles, the lenses effectively filtered out the undesirable blue light (400-510 nm), demonstrating substantial protection (22-71%) while maintaining high transparency (80-96%) for the desirable light (511-780 nm). The maximum protection level reaches a peak of 79% at 455 nm, aligned with the emission peak for the blue light sourced from LEDs in consumer displays. The presence of silver nanoparticles was found to have an insignificant impact on the water content of the developed contact lenses. The lenses maintained high water retention levels within the range of 50-70 wt %, comparable to commercial contact lenses. The optical performance of the developed lenses remains unaffected in both artificial tears and contact lens storage solution over a month with no detected leakage of the nanoparticles. Additionally, the MTT assay confirmed that the lenses were biocompatible and noncytotoxic, maintaining cell viability at over 85% after 24 h of incubation. These lenses could be a potential solution to protect against the most intense wavelengths emitted by consumer displays and offer a remedy to counteract the deleterious effects of prolonged blue light exposure.
Corporate social responsibility has been extensively discussed and linked to the firm performance by the researchers. However, a significant research gap remains unexplored and that is measuring the association between corporate social responsibility, passenger satisfaction, and loyalty in the context of two international airports in China. This research also measures the moderating impact of green human resources management on the relationship between CSR, passengers' satisfaction, and loyalty. Data from two international airports in China were collected through a questionnaire. A total of 269 questionnaires were used for statistical analysis using Smart PLS 3.3. The findings from the statistical analysis revealed that corporate social responsibility in the airport affected passenger satisfaction and loyalty positively and significantly. Moreover, green human resource management in an airport plays a moderating role between corporate social responsibility, passengers' satisfaction, and loyalty. Overall, the study's findings enrich the literature on CSR, customer satisfaction, and loyalty, portray GHRM's role in the airport setting, and suggest practical indications for services industries. Discussions, limitations, and future recommendations are also given.
INTRODUCTION: The Microsoft HoloLens is a head-mounted mixed reality device, which allows for overlaying hologram-like computer-generated elements onto the real world. This technology can be combined with preprocedural ultrasound during thoracic epidural placement to create a visual of the ideal needle angulation and trajectory in the users' field of view. This could result in a technically easier and potentially safer alternative to traditional blind landmark techniques. METHODS: Patients were randomly assigned to one of two groups: (1) HoloLens-assisted thoracic epidural technique (intervention-group H) or (2) traditional thoracic epidural technique (control-group C). The primary outcome was needling time (defined as skin puncture to insertion of epidural catheter) during the procedure. The secondary outcomes were number of needle punctures, number of needle movements, number of bone contacts, and epidural failure. Procedural pain and recovery room pain levels were also evaluated. RESULTS: Eighty-three patients were included in this study. The primary outcome of procedure time was reduced in the HoloLens group compared with control (4.5 min vs 7.3 min, p=0.02, 95% CI), as was the number of needle movements required (7.2 vs 14.4, p=0.01), respectively. There was no difference in intraprocedure or postprocedure pain, bone contacts, or total number of needle punctures. Three patients in the control group experienced epidural failure versus one patient in the HoloLens group. CONCLUSIONS: This study shows that thoracic epidural placement may be facilitated by using a guidance hologram and may be more technically efficient. TRIAL REGISTRATION NUMBER: NCT04028284.
BACKGROUND: Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians. METHODS: Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios. An initial crisis scenario (pre-test) was followed by debriefing with a trained facilitator and a second crisis scenario (immediate post-test). Participants returned for a third crisis scenario 3-6 months later (retention post-test). RESULTS: For the 48 participants included in the final analysis, age negatively correlated with baseline Global Rating Scale (GRS; r=-0.30, P<0.05) and technical checklist scores (r=-0.44, P<0.01). However, only years in practice and prior simulation experience, but not age, were significant in a subsequent stepwise regression analysis. Learning from simulation-based education was shown with a mean difference in scores from pre-test to immediate post-test of 2.28 for GRS score (P<0.001) and 1.69 for technical checklist correct score (P<0.001); learning was retained for 3-6 months. Only prior simulation experience was significantly correlated with a decreased change in learning (r=-0.30, P<0.05). CONCLUSIONS: A reduced amount of prior simulation training and increased years in practice, but not age on its own, were significant predictors of low baseline crisis resource management performance. Simulation-based education leads to crisis resource management learning that is well retained for 3-6 months, regardless of age or years in practice.
Internship and Residency , Physicians , Humans , Prospective Studies , Clinical Competence , Canada
Background: High turnover rates among nurses are a global concern due to the shortage of skilled professionals and increasing demand for high-quality healthcare. This study aims to enhance understanding of organizational fit by examining the impact of Person-organization fit (P-O fit) on organizational loyalty through the mediating role of organizational support and service quality, and the moderating impact of role ambiguity. Methods: Using a convenience sampling technique, we employed a survey methodology by developing a questionnaire. Data were collected from a sample of 614 nurses in five different healthcare sectors in China. Employing SmartPLS 3.3, we conducted a Structural Equation Modeling (SEM) analysis to examine the relationships among the specified variables. Results: The findings of the structural analysis suggest that the P-O fit influences organizational loyalty in the healthcare sector. Organizational support and service quality were identified as partial mediators of the P-O fit-organizational loyalty link. Additionally, the role of ambiguity represented a negative moderating impact between service quality and organizational loyalty. Discussion: Overall, the study's findings extend the understanding of person-organization fit, organizational support, service quality, role ambiguity, and organizational loyalty in the context of healthcare sectors and offer implications for medical authorities. Discussions, limitations, practical implications, and suggestions for further research are also provided.
Although intelligence has been widely examined in the literature, the correlation of emotional intelligence (EI) has with virtual leadership, work stress, work burnout, and job performance in the nursing profession needs further consideration. Prior studies have confirmed that leadership style and emotional intelligence massively contribute to better outcomes in the nursing profession. Based on these confirmations, this research intended to explore the impact of virtual leadership and EI on work stress, work burnout, and job performance among nurses during the COVID-19 pandemic. A convenient sampling technique was adopted to select the data sample. To analyze our hypotheses, 274 self-reported surveys were distributed in five tertiary hospitals in Pakistan through a cross-sectional quantitative research design. The hypotheses were tested with SmartPLS-3.3.9. Our findings revealed that virtual leadership and EI have considerably influenced nurses' work stress, burnout level, and job performance. The study concludes that EI significantly moderates virtual leadership and psychological stress among nurses.
PURPOSE: Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system. METHODS: This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored. RESULTS: In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender. CONCLUSION: We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.
RéSUMé: OBJECTIF: La formation médicale fondée sur les compétences (FMFC) repose sur des évaluations fréquentes des stagiaires en milieu de travail, ce qui donne l'occasion de refléter les préjugés conscients et implicites dans ces évaluations. Notre objectif était d'examiner l'influence du genre des résident·es et des professeur·es sur les évaluations de la performance des résident·es au sein d'un système de FMFC. MéTHODE: Cette étude de cohorte rétrospective s'est déroulée d'août 2017 à janvier 2021 à l'aide des données d'évaluation des résident·es provenant de deux évaluations en milieu de travail : L'évaluation de l'anesthésie clinique par événement (ACEA Anesthesia Clinical Encounter Assessment) et les Actes professionnels non supervisés (APNS). Des données autodéclarées sur le genre ont également été extraites. Le critère d'évaluation principal, soit les différences fondées sur le genre dans les cotes de confiance des résident·es sur l'ACEA et les APNS, a été évalué à l'aide d'une régression logistique à effets mixtes, les différences étant rapportées par les rapports de cotes et les intervalles de confiance (α = 0,01). Les différences fondées sur le genre dans la réception des commentaires en texte libre sur l'ACEA et les APNS ont également été explorées. RéSULTATS: Au total, 14 376 évaluations ACEA et 4467 évaluations APNS ont été analysées. Il n'y avait pas de différences significatives dans les cotes de confiance obtenues avec l'un ou l'autre des outils d'évaluation entre les résidents et les résidentes. Indépendamment du genre de la personne réalisant l'évaluation, les taux de confiance entre les résidentes et les résidents n'étaient pas significativement différents pour toutes les années de formation postdoctorale. De plus, les résident·es ont reçu des commentaires liés à leurs forces et leurs actes sur les deux évaluations à des fréquences comparables, quel que soit le genre du corps professoral. CONCLUSION: Nous n'avons constaté aucune différence fondée sur le genre dans les cotes de confiance telles qu'évaluées par les ACEA et les APNS, ce qui suggère une absence de préjugés genrés envers les résident·es au sein de ce système de FMFC. Compte tenu de l'hétérogénéité considérable en matière de clémence des évaluateurs et évaluatrices, les travaux futurs seraient plus fiables s'ils utilisaient des scores ajustés en fonction de ladite clémence plutôt que des scores bruts.
Anesthesia , Internship and Residency , Humans , Male , Female , Retrospective Studies , Sexism , Competency-Based Education , Faculty, Medical , Clinical Competence
BACKGROUND: Aortic aneurysms occur when the aorta, the body's largest artery, grows in size, and can occur in the thoracic or abdominal aorta. The approaches to repair aortic aneurysms include directly exposing the aorta and replacing the diseased segment via open repair, or endovascular repair. Endovascular repair uses fluoroscopic-guidance to access the aorta and deliver a device to exclude the aneurysmal aortic segment without requiring a large surgical incision. Endovascular repair can be performed under a general anesthetic, during which the unconscious patient is paralyzed and reliant on an anesthetic machine to maintain the airway and provide oxygen to the lungs, or a loco-regional anesethetic, for which medications are administered to provide the person with sufficient sedation and pain control without requiring a general anesthetic. While people undergoing general anesthesia are more likely to remain still during surgery and have a well-controlled airway in the event of unanticipated complications, loco-regional anesthesia is associated with fewer postoperative complications in some studies. It remains unclear which anesthetic technique is associated with better outcomes following the endovascular repair of aortic aneurysms. OBJECTIVES: To evaluate the benefits and harms of general anesthesia compared to loco-regional anesthesia for endovascular aortic aneurysm repair. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search was 11 March 2022. SELECTION CRITERIA: We searched for all randomized controlled trials that assessed the effects of general anesthesia compared to loco-regional anesthesia for endovascular aortic aneurysm repairs. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: all-cause mortality, length of hospital stay, length of intensive care unit stay. Our secondary outcomes were: incidence of endoleaks, requirement for re-intervention, incidence of myocardial infarction, quality of life, incidence of respiratory complications, incidence of pulmonary embolism, incidence of deep vein thrombosis, and length of procedure. We planned to use GRADE methodology to assess the certainty of evidence for each outcome. MAIN RESULTS: We found no studies, published or ongoing, that met our inclusion criteria. AUTHORS' CONCLUSIONS: We did not identify any randomized controlled trials that compared general versus loco-regional anesthesia for endovascular aortic aneurysm repair. There is currently insufficient high-quality evidence to determine the benefits or harms of either anesthetic approach during endovascular aortic aneurysm repair. Well-designed prospective randomized trials with relevant clinical outcomes are needed to adequately address this.
Anesthesia, Conduction , Anesthetics, General , Aortic Aneurysm, Abdominal , Endovascular Procedures , Humans , Anesthesia, Conduction/adverse effects , Anesthesia, General/adverse effects , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Prospective Studies , Quality of Life
Innovation in medical education is not only inevitable but a requirement. Manikin-based simulation is currently the gold standard for supplemental clinical training; however, this modality requires significant equipment and personnel to operate. Virtual reality (VR) is emerging as a new method of delivering medical simulation sessions that requires less infrastructure but also allows for greater accessibility and flexibility. VR has slowly been integrated into the medical curriculum in some hospitals; however, more widespread adoption would transform the delivery of medical education for future clinicians. This tutorial introduces educators to the BUILD REALITY (begin, use, identify, leverage, define, recreate, educate, adapt, look, identify, test, amplify) framework, a series of practical tips for designing and implementing a VR-based medical simulation environment in their curriculum. The suggestions are based on the relevant literature and the authors' personal experience in creating and implementing VR environments for medical trainees. Altogether, this paper provides guidance on conducting a needs assessment, setting objectives, designing a VR environment, and incorporating the session into the broader medical curriculum.
Wound healing is a huge challenge worldwide causing enormous financial burden on healthcare systems. Although conventional wound dressings, such as hydrogels, bandages, and foams, facilitate wound healing, they lack the ability to monitor the wound healing process. Here, hydrogel wound dressings in the form of auxetic structures were developed by a digital light processing (DLP) printer. Paper-based colorimetric sensors were incorporated with the 3D printed auxetic hydrogel skin wound patches for monitoring the wound status through detecting pH levels and glucose concentrations. The paper-based sensors are profoundly cost-effective and were found to be capable of monitoring the wound's conditions. The developed wound dressings may assist in preventing escalation of the acute wounds into chronic stages in diabetics.
Hydrogels , Soft Tissue Injuries , Humans , Hydrogels/therapeutic use , Bandages , Wound Healing , Skin , Printing, Three-Dimensional
BACKGROUND: Neuraxial anesthesia is conventionally performed using a landmark-based technique. Preprocedural ultrasound is often used in challenging clinical scenarios to identify an ideal needle path. The procedure is then carried out by the operator recreating the ultrasound needle path from memory. We suggest that a needle guidance system using the Microsoft HoloLens mixed reality headset, which projects a hologram of the ideal needle path, can assist operators in replicating the correct needle angulation and result in fewer needle passes. OBJECTIVE: The objective of the study was to develop software for the mixed reality HoloLens headset, which could be used to augment the performance of neuraxial anesthesia, and establish its face validity in lumbar spine phantom models. METHODS: We developed an ultrasound transducer marker and software for the HoloLens, which registers the position and angulation of the ultrasound transducer during preprocedural scans. Once an image of a clear path from skin to the intrathecal space is acquired, a hologram of the ideal needle path is projected onto the user's visual field. The ultrasound probe is removed while the hologram remains in the correct spatial position to visualize the needle trajectory during the procedure as if conducting real-time ultrasound. User testing was performed using a lumbar spine phantom. RESULTS: Preliminary work demonstrates that novice (2 anesthesia residents) and experienced operators (5 attending anesthesiologists) can rapidly learn to use mixed reality holograms to perform neuraxial anesthesia on lumbar spine phantoms. CONCLUSIONS: Our study shows promising results for performing neuraxial anesthesia in phantoms using the HoloLens. Although this may have wide-ranging implications for image-guided therapies, further study is required to quantify the accuracy and safety benefit of using holographic guidance. TRIAL REGISTRATION: ClinicalTrials.gov NCT04028284; https://clinicaltrials.gov/ct2/show/NCT04028284.
Surface functionalization of metallic nanoparticles (NPs) with external groups can be engineered to fabricate sensors that are responsive to various stimuli like temperature, pH, and numerous ions. Herein, we report the synthesis of gold nanoparticles (GNPs) functionalized with 3-mercaptopropionic acid (GNPs-MPA) and the doping of these nanoparticles into hydrogel materials using the breathing-in/breathing-out (BI-BO) method. MPA has a carboxyl group that becomes protonated and, thus, ionized at a pH below its pKa (4.32); hence, the GNPs-MPA solutions and gels were mostly pH-responsive in the range of 3-5. Optical properties were assessed through ultraviolet-visible (UV-Vis) spectroscopy, namely: transmission and absorption, and the parameters used to quantify the pH changes were the full width at half maximum (FWHM) and position of surface plasmon resonance (SPR). The solutions and gels gradually changed their colors from red to indigo with pH decrementation from 5 to 3, respectively. Furthermore, the solutions' and doped gels' highest FWHM sensitivities towards pH variations were 20 nm and 55 nm, respectively, while the SPR's position sensitivities were 18 nm and 10 nm, respectively. Also, transmission and scanning electron microscopy showed synchronized dispersion and aggregation of NPs with pH change in both solution and gel forms. The gel exhibited excellent repeatability and reversibility properties, and its response time was instantaneous, which makes its deployment as a colorimetric pH-triggered sensor practical. To the best of our knowledge, this is the first study that has incorporated GNPs into hydrogels utilizing the BI-BO method and demonstrated the pH-dependent optical and colorimetric properties of the developed nanocomposites.
Integration of nanomaterials into hydrogels has emerged as a prominent research tool utilized in applications such as sensing, cancer therapy, and bone tissue engineering. Wearable contact lenses functionalized with nanoparticles have been exploited in therapeutics and targeted therapy. Here, we report the fabrication of gold and silver nanocomposite commercial contact lenses using a breathing-in/breathing-out (BI-BO) method, whereby a hydrated contact lens is shrunk in an aprotic solvent and then allowed to swell in an aqueous solution containing nanoparticles. The morphology and optical properties of the gold and silver nanoparticles were characterized through transmission electron microscopy and ultraviolet-visible spectroscopy. The transmission spectra of nanocomposite contact lenses indicated that the nanoparticles' loading amount within the lens depended primarily on the number of BI-BO cycles. Nanocomposites were stable for a minimum period of 1 month, and no nanoparticle leaching was observed. Wettability and water content analysis of the nanocomposites revealed that the contact lenses retained their intrinsic material properties after the fabrication process. The dispersion of the nanoparticles within the contact lens media was determined through scanning electron microscopy imaging. The nanocomposite lenses can be deployed in color filtering and antibacterial applications. In fact, the silver nanocomposite contact lens showed blue-light blocking capabilities by filtering a harmful high-energy blue-light range (400-450 nm) while transmitting the visible light beyond 470 nm, which facilitates enhanced night vision and color distinction. The ease of fabricating these nanocomposite contact lenses via the BI-BO method could enable the incorporation of nanoparticles with diverse morphologies into contact lenses for various biomedical applications.
Contact Lenses , Metal Nanoparticles , Nanocomposites , Gold , Hydrogels/chemistry , Silver
Diabetes mellitus is a chronic disease requiring a careful management to prevent its collateral complications, such as cardiovascular and Alzheimer's diseases, retinopathy, nephropathy, foot and hearing impairment, and neuropathy. Self-monitoring of blood glucose at point-of-care settings is an established practice for diabetic patients. However, current technologies for glucose monitoring are invasive, costly, and only provide single snapshots for a widely varying parameter. On the other hand, tears are a source of physiological information that mirror the health state of an individual by expressing different concentrations of metabolites, enzymes, vitamins, salts, and proteins. Therefore, the eyes may be exploited as a sensing site with substantial diagnostic potential. Contact lens sensors represent a viable route for targeting minimally-invasive monitoring of disease onset and progression. Particularly, glucose concentration in tears may be used as a surrogate to estimate blood glucose levels. Extensive research efforts recently have been devoted to develop smart contact lenses for continual glucose detection. The latest advances in the field are reviewed herein. Sensing technologies are described, compared, and the associated challenges are critically discussed.
BACKGROUND: Workplace-based assessment (WBA) is key to a competency-based assessment strategy. Concomitantly with our programme's launch of competency-based medical education, we developed an entrustment-based WBA, the Anesthesia Clinical Encounter Assessment (ACEA), to assess readiness for independent practice of competencies essential to perioperative patient care. This study aimed to examine validity evidence of the ACEA during postgraduate anaesthesiology training. METHODS: The ACEA comprises an eight-item global rating scale (GRS), an overall independence rating, an eight-item checklist, and case details. ACEA data were extracted for University of Toronto anaesthesia residents from July 2017 to January 2020 from the programme's online assessment portal. Validity evidence was generated following Messick's validity framework, including response process, internal structure, relations with other variables, and consequences. RESULTS: We analysed 8664 assessments for 137 residents completed by 342 assessors. From generalisability analysis, 10 independent observations (two assessments each from five assessors) were sufficient to achieve a reliability threshold of ≥0.70 for in-training assessments. A composite GRS score of 3.65/5 provided optimal sensitivity (93.6%) and specificity (90.8%) for determining entrustment on receiver operator characteristic curve analysis. Test-retest reliability was high (intraclass correlation coefficient [ICC2,1]=0.81) for matched assessments within 14 days of each other. Composite GRS scores differed significantly between residents based on their training level (P<0.0001) and correlated highly with overall independence (0.91, P<0.001). The internal consistency of the GRS (α=0.96) was excellent. CONCLUSIONS: This study supports the validity of the ACEA for assessing the competence of residents performing perioperative care and supports its use in competency-based anaesthesiology training.
Anesthesia , Anesthesiology , Education, Medical , Internship and Residency , Anesthesiology/education , Clinical Competence , Educational Measurement , Humans , Reproducibility of Results
