Development and Implementation of Video-Recorded Simulation Scenarios to Facilitate Case-Based Learning Discussions for Medical Students' Virtual Anesthesiology Clerkship.

Introduction: The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible. Methods: We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum. Results: Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning. Discussion: We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula.

Current Use, Training, and Barriers of Point-of-Care Ultrasound in Anesthesiology: A National Survey of Veterans Affairs Hospitals.

OBJECTIVES: The purpose of this study was to determine current use, training needs, and barriers to point-of-care ultrasound (POCUS) use among anesthesiologists in practice. DESIGN: Multicenter, prospective, observational study. SETTING: Anesthesiology departments in the Veterans Affairs Healthcare System in the United States. PARTICIPANTS: Chiefs of staff and chiefs of anesthesiology departments. INTERVENTIONS: A web-based survey was conducted between June 2019 and March 2020. Chiefs of staff answered questions about facility-level POCUS use, training, competency, and policies. Anesthesiology chiefs responded to a follow-up survey with specialty-specific POCUS questions. The results of the 2020 survey were compared with a similar survey conducted by the authors' group in 2015. MEASUREMENTS AND MAIN RESULTS: All chiefs of staff (n = 130) and 77% of anesthesiology chiefs (n = 96) completed the survey. The most common POCUS applications used were central and peripheral vascular access (69%-72%), peripheral nerve blocks (66%), and evaluation of cardiac function (29%-31%). Compared with 2015, there was a statistically significant increase in desire for training (p = 0.00015), but no significant change in POCUS use (p = 0.31). Training was most desired for volume-status assessment (52%), left ventricular function (47%), pneumothorax (47%), central line placement (40%), peripheral nerve blocks (40%), and pleural effusion (40%). The most common barriers to POCUS use were lack of funding for training (35%), trained providers (33%), and training opportunities (28%). CONCLUSIONS: A significant increase in desire for POCUS training was seen among anesthesiologists practicing in the Veterans Affairs healthcare system since 2015, and lack of training continues to be a top barrier for POCUS use among anesthesiologists.

Development and Use of an Induction of General Endotracheal Anesthesia Checklist Assessment for Medical Students in a Clinical Setting During Their Introductory Anesthesiology Clerkship.

Background: The American Association of Medical Colleges deemed performing lifesaving procedures, such as airway management, a necessary medical student competency for transitioning to residency. Anesthesiology clerkships provide the unique opportunity for medical students to practice these procedures in a safe and controlled environment. We aimed to develop a checklist that assesses medical students' ability to perform the main steps of a general anesthesia induction with endotracheal intubation in the clinical setting. Methods: We created a Checklist containing items aligned with our clerkship objectives. We modified it after receiving feedback and trialing it in the clinical setting. Medical students were evaluated with the Checklist using a pre- and post-clerkship study design: (1) in a simulation setting at the beginning of the clerkship; and (2) in the operating room at the end of the clerkship. Using paired t-tests, we calculated pre- and post-clerkship Checklist scores to determine curriculum efficacy. A P value of <.05 was determined to be statistically significant. We examined rater agreement between overall scores with intraclass correlation coefficients (ICC). Results: Thirty medical students participated in the study. The ICC for agreement was 0.875 (95% confidence interval [CI], 0.704-0.944). The ICC for consistency was 0.897 (95% CI, 0.795-0.950). There was a statistically significant improvement in the score from baseline to final evaluation of 3.6 points (95% CI, 2.5-5.2; P = .001). Conclusions: The statistically significant change in Checklist scores suggests that our medical students gained knowledge and experience during the introductory clerkship inducing general anesthesia and were able to demonstrate their knowledge in a clinical environment.

Management of patients with the Intravascular Ventricular Assist System (iVAS) for non-cardiac surgery.

Intravascular ventricular assist system (iVAS) is an investigative device in clinical trials for the management of advanced heart failure. It works on the principle of counterpulsation, similar to the classic intra-aortic balloon counterpulsation (IABP). We present a case of a 66-year-old man with iVAS in situ who required emergency laparotomy for a strangulated umbilical hernia. Patients with mechanical circulatory devices (MCD) are presenting more frequently for emergency and even elective noncardiac operations. Managing such patients poses significant challenges to the perioperative team due to its novelty and paucity of management recommendations.

Design and evaluation of a portable negative pressure hood with HEPA filtration to protect health care workers treating patients with transmissible respiratory infections.

BACKGROUND: To mitigate potential exposure of healthcare workers (HCWs) to SARS-CoV-2 via aerosol routes, we have developed a portable hood which not only creates a barrier between HCW and patient, but also utilizes negative pressure with filtration of aerosols by a high-efficiency particulate air filter. MATERIAL AND METHODS: The hood has iris-port openings for access to the patient, and an opening large enough for a patient's head and upper torso. The top of the hood is a high-efficiency particulate air filter connected to a blower to apply negative pressure. We determined the aerosol penetration from outside to inside in laboratory experiments. RESULTS: The penetration of particles from within the hood to the breathing zones of HCWs outside the hood was near 10-4 (0.01%) in the 200-400 nm size range, and near 10-3 (0.1%) for smaller particles. Penetration values for particles in the 500 nm-5 µm range were below 10-2 (1%). Fluorometric analysis of deposited fluorescein particles on the personal protective equipment of an HCW revealed that negative pressure reduces particle deposition both outside and inside the hood. CONCLUSIONS: We find that negative pressure hoods can be effective controls to mitigate aerosol exposure to HCWs, while simultaneously allowing access to patients.

Procalcitonin in patients with acute myocardial infarction.

Acute myocardial infarction induces an inflammatory reaction. We related conventional inflammatory parameters including C-reactive protein, erythrocyte sedimentation rate, white blood cell count and axillary temperature to plasma concentrations of procalcitonin in patients with acute myocardial infarction. In a prospective-descriptive study, we evaluated 54 patients with acute myocardial infarction. During a time period of 8 days following myocardial infarction, C-reactive protein, erythrocyte sedimentation rate, white blood cell count and axillary temperature as well as the plasma concentrations of procalcitonin were measured. Maximal procalcitonin remained normal (below 0.5 microgram/L) in patients with uncomplicated acute myocardial infarction. This contrasted with results obtained from patients additionally afflicted by pulmonary edema and cardiogenic shock, in whom maximal procalcitonin increased up to 5.24 micrograms/L. Resuscitation after cardiac arrest and/or concomitant bacterial infection increased procalcitonin to a maximal value of 134 micrograms/L, which was independent of the severity of left heart failure. Conventional inflammatory parameters were all significantly increased even in the absence of cardiac and non-cardiac complications of acute myocardial infarction. In conclusion, procalcitonin increases in patients with acute myocardial infarction only if associated with severe left heart failure, resuscitation after cardiac arrest or in the presence of bacterial infections. Thus, procalcitonin may help to elucidate the etiology of systemic inflammatory response during the early course of acute myocardial infarction.