Medical students' perspectives on and understanding of anesthesiology: a Canadian cross-sectional survey.

PURPOSE: In Canada, three out of 17 medical schools do not mandate an anesthesia rotation in their clerkship curriculum. Understanding the effects of a mandatory anesthesiology rotation is important in determining its value to the specialty and guiding decision-making for medical educators. We sought to determine whether a mandatory anesthesia rotation affected students' understanding of anesthesiology, as well as their perspectives on anesthesia. METHODS: We conducted an anonymous cross-sectional survey of Canadian medical students graduating in 2021. Our survey consisted of 46 questions related to student's perspectives of anesthesiology, understanding of anesthesia, their interest in the specialty, and participant's demographics. This included 16 Likert-scale questions, 19 quiz-style questions, four free-text response questions, and seven demographics questions. The survey was hosted by SurveyMonkey® (SurveyMonkey Inc., San Mateo, CA, USA) and distributed to the participants by each individual institution. RESULTS: We collected a total of 331 responses across 13 different Canadian medical schools, representing a 17.3% response rate of students surveyed and 11.7% of all graduating medical Canadian students in 2021. A mandatory rotation in anesthesiology was associated with a more positive perspective (P = 0.01) but not understanding (P = 0.07) of the specialty. A mandatory rotation was not related to students' application to anesthesiology at a statistically significant level (P = 0.06). CONCLUSIONS: The results of this national survey study show the benefits of including a mandatory clerkship rotation in anesthesiology, namely on increasing positive perceptions of the specialty, while also revealing avenues for future research and insights on how to further optimize a mandatory anesthesiology rotation in clerkship.

RéSUMé: OBJECTIF: Au Canada, trois facultés de médecine sur 17 n'exigent pas de stage clinique en anesthésie dans leur programme. Il est important de comprendre les effets d'un stage obligatoire en anesthésiologie afin de déterminer sa valeur pour la spécialité et d'orienter la prise de décision en matière d'éducation médicale. Nous avons cherché à déterminer si un stage obligatoire en anesthésie affectait la compréhension de l'anesthésiologie par les étudiant·es, ainsi que leurs points de vue sur l'anesthésie. MéTHODE: Nous avons mené un sondage transversal anonyme auprès d'étudiant·es en médecine qui ont obtenu leur diplôme en 2021 au Canada. Notre sondage comportait 46 questions portant sur leur point de vue sur l'anesthésiologie, leur compréhension de l'anesthésie, leur intérêt pour la spécialité et les caractéristiques démographiques des personnes interrogées. Le sondage comprenait 16 questions sur l'échelle de Likert, 19 questions courtes de type quiz, quatre questions à réponse libre et sept questions démographiques. Le sondage était hébergé par SurveyMonkey® (SurveyMonkey Inc., San Mateo, Californie, États-Unis) et a été distribué aux participant·es par chaque institution. RéSULTATS: Nous avons recueilli un total de 331 réponses dans 13 facultés de médecine canadiennes différentes, ce qui représente un taux de réponse de 17,3 % des étudiant·es interrogé·es et de 11,7 % de tous les étudiant·es en médecine diplômé·es en 2021 au Canada. Un stage obligatoire en anesthésiologie était associé à une perspective plus positive (P = 0,01) mais pas à une meilleure compréhension (P = 0,07) de la spécialité. Un stage obligatoire n'était pas lié aux demandes d'admission en anesthésiologie à un niveau statistiquement significatif (P = 0,06). CONCLUSION: Les résultats de cette enquête nationale montrent les avantages de l'inclusion d'un stage obligatoire en anesthésiologie, notamment pour accroître les perceptions positives de la spécialité, tout en révélant des pistes de recherche futures et des idées sur la façon d'optimiser davantage un stage clinique obligatoire en anesthésiologie.

Characteristics of good clinical teachers in anesthesiology from medical students' perspective: a qualitative descriptive study.

PURPOSE: Learning needs are influenced by the stage of learning and medical specialty. We sought to investigate the characteristics of a good clinical teacher in anesthesiology from the medical students' perspective. METHODS: We conducted a qualitative descriptive study to analyze written comments of medical students about their clinical teachers' performances. Our analysis strategy was the inductive content analysis method. The results are reported as a descriptive summary with major themes as the final product. RESULTS: Our study identified four themes. The first theme, teachers' individual characteristics, includes characteristics that are usually more related to students' subjective experiences and feelings. The second theme, teachers' characteristics that advance student learning, seems to be one of the most important contributions to learning because it increases the practice of procedural skills. The third theme, teachers' characteristics that prepare students for success, shows characteristics that facilitate students' learning by promoting a healthy and safe environment. Lastly, the fourth theme, characteristics related to teaching approaches, includes characteristics that can guide clinical teachers more objectively. CONCLUSION: Our analysis of the written comments of medical students identified many characteristics of a good clinical teacher that were organized in four different themes. These themes contribute to expand on existing understandings of clinical teaching in the anesthesiology clerkship environment, and add new interpretations that can be reflected upon and explored by other clinical educators.

RéSUMé: OBJECTIF: Les besoins d'apprentissage sont influencés par le stade d'apprentissage et la spécialité médicale. Nous avons cherché à étudier les caractéristiques d'un bon enseignant clinique en anesthésiologie selon la perspective des étudiants en médecine. MéTHODE: Nous avons mené une étude descriptive qualitative pour analyser les commentaires écrits des étudiants en médecine sur les performances de leurs enseignants cliniques. Notre stratégie d'analyse était la méthode inductive d'analyse de contenu. Les résultats sont présentés sous forme de résumé descriptif avec les principaux thèmes comme produit final. RéSULTATS: Notre étude a identifié quatre thèmes. Le premier thème, les caractéristiques individuelles des enseignants, comprend des caractéristiques qui sont habituellement davantage liées aux expériences subjectives et aux sentiments des étudiants. Le deuxième thème, les caractéristiques de l'enseignant qui font progresser l'apprentissage des étudiants, semble être l'une des contributions les plus importantes à l'apprentissage parce qu'elle augmente la pratique des compétences procédurales. Le troisième thème, les caractéristiques de l'enseignant qui préparent les étudiants à la réussite, présente des caractéristiques qui facilitent l'apprentissage des étudiants en favorisant un environnement sain et sécuritaire. Enfin, le quatrième thème, les caractéristiques liées aux approches pédagogiques, comprend des caractéristiques qui peuvent guider les enseignants cliniques de manière plus objective. CONCLUSION: Notre analyse des commentaires écrits des étudiants en médecine a identifié de nombreuses caractéristiques d'un bon enseignant clinique qui étaient organisées en quatre thèmes différents. Ces thèmes contribuent à élargir les connaissances existantes de l'enseignement clinique dans l'environnement de stage clinique en anesthésiologie et ajoutent de nouvelles interprétations qui peuvent inciter d'autres éducateurs cliniques à y réfléchir et à les explorer.

Measurement of forces applied using a Macintosh direct laryngoscope compared with a Glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: A randomised controlled trial.

BACKGROUND: In patients with predictive features associated with easy direct laryngoscopy, videolaryngoscoy with the GlideScope has been shown to require less force when compared with Macintosh direct laryngoscopy. OBJECTIVE: The aim of this study was to compare forces applied with Glidescope vs. Macintosh laryngoscopes in patients with predictive features associated with difficult direct laryngoscopy. DESIGN: A randomised study. SETTING: Toronto General Hospital, a university tertiary centre in Canada. PATIENTS: Forty-four patients aged over 18 years, with one or more features of difficult intubation, undergoing elective surgery requiring single-lumen tracheal intubation. INTERVENTION: We measured the force applied to oropharyngeal tissues by attaching three FlexiForce Sensors (A201-25) to the concave surface of Macintosh and GlideScope laryngoscope blades.Anaesthetists or experienced anaesthesia residents performed laryngoscopies with both devices in a randomised sequence. MAIN OUTCOME MEASURES: The primary outcome was peak force. The secondary outcomes were average force and impulse force. The latter is the integral of the force over the time during which the force acted. RESULTS: Complete data were available for 40 individuals. Peak and average forces decreased with GlideScope (17 vs. 21 N, P = 0.03, and 6 vs. 11 N, P < 0.001, respectively). Laryngoscopy time increased with the GlideScope (30 vs. 18 s, P < 0.001), resulting in similar median impulse forces (206 vs. 175 N, P = 0.92). CONCLUSION: GlideScope laryngoscopy resulted in reduced peak and average forces, but as the laryngoscopy duration increased, the product of force and time (impulse force) was similar with both devices. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01814176.

A literature review on observational learning for medical motor skills and anesthesia teaching.

Motor skill practice is very important to improve performance of medical procedures and could be enhanced by observational practice. Observational learning could be particularly important in the medical field considering that patients' safety prevails over students' training. The mechanism of observational learning is based on the mirror neuron system, originally discovered in the monkey pre-motor cortex. Today we know that humans have a similar system, and its role is to understand and reproduce the observed actions of others. Many studies conclude that humans are able to plan and to make movements based on visual information by mapping a representation of observed actions, especially when the motor system is committed to do it. Moreover most researchers considered observational learning effective for complex skills, such as medical procedures. Additionally, observational learning could play a relevant role during anesthesia training since the learner works in pairs most of the time (dyad practice). Some teaching approaches should be taken into consideration: an implicit engagement of the observer motor system is required, immediate feedback seems to have an important effect, and a combination of observational and physical practice could be better than physical practice alone. In an environment where effectiveness and efficacy are essential, observational learning seems to fit well.

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose.

PURPOSE: The primary objective of our study was to determine the minimum intravenous dose of carbetocin required to produce adequate uterine contraction in 95% of women (effective dose [ED](95)) undergoing elective Cesarean delivery (CD). METHODS: Eighty term pregnant women with low risk for postpartum hemorrhage (PPH) undergoing elective CD under spinal anesthesia were randomly allocated to receive carbetocin intravenously in doses of 80 µg, 90 µg, 100 µg, 110 µg, or 120 µg upon delivery. The consultant obstetrician evaluated the efficacy of the patient's uterine tone as satisfactory or unsatisfactory. In case of unsatisfactory uterine tone, additional uterotonics were administered as per routine institutional practice. Side effects were monitored during the study period. The main outcome measure was satisfactory uterine tone at two minutes after carbetocin administration. RESULTS: Satisfactory uterine tone was obtained in 70 subjects (87%) within the dose range of 80-120 µg of carbetocin. It was not possible to calculate the ED(95) of carbetocin due to the even distribution of women with satisfactory uterine tone across all dose groups (P = 0.99). Similarly, the side effects were similar across all dose groups. There was a high overall incidence of hypotension (55%) following the administration of carbetocin. CONCLUSIONS: In women at low risk for PPH undergoing elective CD, carbetocin doses of 80-120 µg are similarly effective. There is a high incidence of hypotension associated with carbetocin in these doses, and further studies with doses lower than 80 µg are warranted to assess the balance of efficacy and side effects. This trial was registered at www.clinicaltrials.gov (NCT01262742).