Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician-gynecologists.

OBJECTIVE: While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN). METHODS: A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models. RESULTS: The survey was distributed to 556 anesthesiology and 662 obstetrics-gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician-gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001). CONCLUSIONS: ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

Digital Resources for Residency Recruitment: A Pilot Study of What Applicants Really Utilize.

Background: The COVID-19 pandemic in 2020 led to multiple changes in graduate medical education programs across the country, including the switch to virtual interviews for all residency applicants instead of on-site visits. The rapid transition to virtual interviews introduced challenges, including limited opportunities to formally and informally interact with residents and faculty, observe the clinical and educational environments, and explore the local culture and community. As a result, programs were advised to heavily invest in and create comprehensive digital resources including but not limited to video tours and multimedia resources describing programmatic details. Methods: In preparation for the virtual interview season of 2020-2021, digital recruitment materials were created for the University of Nebraska Medical Center's Anesthesiology residency applicants to provide the information that they would traditionally receive during an in-person interview experience. The objectives of the study were (1) to assess which digital materials residency applicants accessed most frequently during the interview season, and (2) to determine if the digital materials were helpful for the residency applicant in best determining program fit as part of the interview process. A post-interview survey and user analytics were analyzed. Results: With a survey response rate of 58% (n = 87 of 150) and a Web-based email-open rate of 98% (n =147 of 150), the data revealed that the favored digital materials were the "What Residents Say" video and the Residency Applicant Handbook. These were also the most helpful for the residency applicant in best determining program fit. Conclusion: This study shows that resources that allowed students to better assess their "fit" in the program were highly accessed and valued, as were detailed descriptions of the clinical and educational aspects of the training program found in the resident handbook.

Assessment of Resident Performance During the Cardiac Anesthesia Rotation: Application of the House Officer Clinical Assessment in Cardiac Anesthesiology.

OBJECTIVE: The assessment of clinical skills was created that evaluates House Officer performance within 13 clinical domains during the Cardiac Anesthesiology rotation to provide an assessment and evaluation process for residents while performing a cardiac anesthetic. DESIGN: A retrospective evaluation of performance assessments over a 33-month period. SETTING: University hospital-based Accreditation Council for Graduate Medical Education accredited Residency Training program. PARTICIPANTS: Anesthesiology house officers within the Department Residency Program. INTERVENTIONS: This House Officer Clinical Assessment was created and implemented as residents rotated through the cardiac anesthesia service. Scores in 13 domain-specific components from this assessment were collected after the attending-resident debrief. MEASUREMENTS AND MAIN RESULTS: Most scores were found to be sufficient to suggest competency, and the evaluation allowed for a more detailed approach to assessment and feedback. The most common aspects of the case in which the residents showed reduced performance and proficiency were the transition off cardiopulmonary bypass and the performance of the transesophageal echocardiogram. Overall, the resident survey showed a positive response to the assessment and the feedback provided during the post-examination debrief. CONCLUSION: The House Officer Clinical Assessment in Cardiac Anesthesiology allows for a more objective assessment of performance for specific portions of the case and allows for improved feedback on performance. Aspects of the evaluation tool and where residents correlate with the Anesthesiology Milestones for residency are discussed, as well as the ability to determine sufficient proficiency with knowledge and skills over the use of subjective rank to determine competency.

Financial Considerations of an Anesthesia Consult Service.

Surgical patients with complex cardiac disease often require noncardiac surgery. There have been recent articles written concerning the role of the cardiothoracic anesthesiologist as a consultant in the operating room as well as outside the operating theatre.1,2 With the evolution of the cardiothoracic anesthesia consult service (CACS), there are many issues regarding medical billing, financial reimbursement, and Medicare rules that anesthesiologists may not be familiar with. This paper will discuss the financial implications of starting a CACS.

Coagulopathy after severe pediatric trauma.

Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.