Facilitated Peer Discussion for Promoting Better Resident Wellness in Anesthesia Trainees: Qualitative Program Evaluation

Fellowship Training in Adult Cardiothoracic Anesthesiology: Navigating the New Educational Landscape as a Result of the Coronavirus Crisis

Background and Aims:This study aimed to highlight differences in success rates and patient outcomes during epidural insertion among anesthesia staff, junior trainees, and staff anesthesiologists.Methods:We included all women who received a labor epidural between January 1, 2020 and April 30, 2022. The cases were divided into three groups: junior residents, senior residents, and staff anesthesiologists.Results:Among 822 cases included in analysis, 92, 240, and 490 catheters were placed by junior residents, senior residents, and staff anesthesiologists, respectively. Although the success rate among junior residents (90.7%) was lower than those of senior residents (97%) and staff anesthesiologists (95.1%), the difference was not significant (P = 0.067). The mean procedural time in minutes was significantly longer in the junior resident’s group (18.1 min) compared to the senior residents (14.18 min) and staff anesthesiologists (14.87 min) (P < 0.001). A significant difference was observed in the number of needle pricks and catheter insertion attempts when comparing the junior residents, senior residents, and staff anesthesiologists’ groups (P < 0.001). In the logistic regression analysis, procedural time remained the only predictor of epidural success.Conclusions:With the success rate above 90%, junior anesthesia trainees require more time and attempts to insert labor epidurals. It is essential that training programs provide opportunities for anesthesia trainees to become proficient in their epidural insertion techniques prior to clinical practice.

This study characterizes the performance and success rate for fiberoptic-guided tracheal tube placement through the air-Q(®) Intubating Laryngeal Airway (air-Q). Using a manikin, anesthesia trainees and staff anesthesiologists, experienced in fiberoptic-guided intubation, performed five consecutive fiberoptic-guided tracheal tube placements via the air-Q. Participant characteristics, procedure segment times, total procedure times, and observed failures were recorded. Linear mixed effect models with random slopes and intercepts were used to assess participant performance. Ten anesthesia trainees and ten staff anesthesiologists participated. Anesthesia trainees were younger and had practiced for fewer years compared to staff anesthesiologists. Gender was equally distributed between the groups. Both segmental and overall procedure times decreased from the first to the fifth trial among all participants, independent of experience level and gender. Overall mean procedure time decreased from 102±31 to 68±14s, representing a relative time reduction of 33% and a mean time difference of 34s [95% confidence interval (CI) 22-47s; p<0.0001]. Tracheal tube placement was successful in all attempts; however, three tracheal tube dislodgements occurred during air-Q removal (overall procedure success 97%). Fiberoptic-guided tracheal tube placement through the air-Q can be performed in a clinically acceptable period of time with high success by operators skilled in fiberoptic-guided intubation. Tracheal tube dislodgement during air-Q removal remains a potential risk that should be emphasized.

In China, the demand for sedation during gastrointestinal endoscopy (GIE) has surged since the introduction of the nationwide Cancer Screening Program in 2012, while anesthesia staffing remains insufficient. Pre-anesthetic evaluation (PAE) is crucial for safe sedation, however, PAE practices in China have not been thoroughly examined. We conducted a national web-based questionnaire survey among anesthesiologists across China from January to February 2024, focusing on PAE and sedation practices for GIE. A total of 413 anesthesiologists from 282 hospitals across the 31 provincial-level administrative regions of mainland China (Taiwan, Hong Kong and Macao were not included) participated. Key findings included: Dual PAE timing (before and on the day of GIE) significantly reduced same-day procedure cancellations (15.2% vs. 31.5%, p < 0.01); Preoperative testing was dominated by non-risk-stratified ECG (95.0%) despite limited evidence; and significant variability existed in assessment strategies among anesthesiologists, unrelated to professional seniority or hospital level. This survey reveals critical gaps in China's PAE practices for GIE. Aligning PAE practices with evidence-based protocols and embracing digital health innovations could optimize perioperative safety and mitigate anesthesia workforce challenges. These measures may significantly enhance perioperative care for GIE patients in China. Moreover, the findings highlight critical educational gaps and provide insights for curriculum design and competency-based training in anesthesia and endoscopy sedation, which may significantly enhance the quality of perioperative care for GIE patients in China.

Introduction&#13;\nSimulation training is widely adopted in clinical medicine. Simulated environment provides a safe condition for participants to practice without any harm inflicted on patients. Within the spectrum of clinical anaesthesia, simulation mannequin was first developed in 1960. The first journal article with description about the use of simulator to teach intubation to anaesthesia residents occurred in 1969. The first report about simulated anaesthesia training was in 1988. Since then, there has been a flourishing trend of adopting this simulation training in clinical anaesthesia, across various subspecialties including obstetric anaesthesia, cardiac anaesthesia. For individual perspective, simulation training expanded beyond skill development into non technical skill training. &#13;\nThis article is to review the impact of simulation training for individual development for anaesthesia residents or trainees. The aim is to evaluate the evidence of simulation training on individual anaesthesia resident performance and improvement on patient outcome. As a result, more vigorous use of simulation is adopted in modular subspecialty anaesthesia and also non-technical skill training for residents.&#13;\n&#13;\nMethods&#13;\nA search of literatures through search engines of Pubmed, Google Scholars, EMBASE, Cochrane library for ‘Simulation for training of clinical anaesthesia’ was done. After limit the search for English language and past 10 years, there are 223 articles. With appropriate exclusion criteria, 25 articles are selected for detail evaluation. &#13;\n&#13;\nResults&#13;\nSimulation has good effects in various aspects. For various anaesthesia subspecialties, simulation-based training can improve trainees’ confidence and capability in handling rare but life-threatening peri-operative crises. For assessments, simulation is an essential part of Israeli Board Examination in Anesthesia with good discriminating power. For technical skill development, simulation-based training can reduce residents’ time requirement to perform cricothyroidotomy and improve successful rate of central line insertion. The specific skill developed can retain for long period of time such as 12 months. For non-technical skills, there are conflicting results in behavioural scores. For patient safety and outcome perspective, there lacks the result from individual simulation-based training study. &#13;\n&#13;\nConclusions&#13;\nSimulation in anaesthesia residents training is a worldwide practice. These simulation training allow residents to have exposure in various anesthesia subspecialty including cardiac, obstetrics, liver transplant. There are specific technical and non-technical skill development. Individual performance particularly time to complete cricothyroidotomy and confidence, understanding of procedures and anatomy by residents are also enhanced. Thus, simulation should be allocated more proportion of anaesthesia resident training in Hong Kong. Although there remains no study showing better patient outcome after simulation-based individual training, future studies should be done to confirm such presence and degree of association with simulation training.

Background and Aims: Early training with supraglottic airway devices (SGAD) are imperative for training. This study was done to assess the oropharyngeal leak pressure (OLP) when 1 st year anaesthesia residents inserted Ambu Aura Gain™ and I-gel ® devices. Materials and Methods: A prospective randomized observational study was conducted on 200 1 st year anesthesia residents for SGAD insertion. The trainees were randomly allocated into groups (Group A: Ambu Aura Gain™ and Group I: I-gel ® ). The OLP was compared in each group along the first attempt success rate, total insertion attempt, insertion time, ease of SGAD insertion, ease of gastric tube insertion, fiberoptic view, and complications associated with Inflatable SGAD aura gain and noninflatable SGAD. Results: The mean OLP was 29.31 ± 5.93 and 30.03 ± 4.84 cmH 2 O for I-gel ® and Ambu Aura Gain™, respectively ( P = 0.348). The first attempt success rate was 96% for I-gel ® and 89% for Ambu Aura Gain™ ( P = 0.06). Effective device insertion time was 28.76 ± 7.74 s for I-gel ® and 38.42 ± 8.05 s for Ambu Aura Gain™ ( P &lt; 0.001). In Group A 7%, 49%, 36%, and 8% of patients had 4, 3, 2, and 1 fiberoptic scores, respectively, and 9%, 54%, 32%, and 5% of patients in Group I had scores of 4, 3, 2, and 1, respectively. Conclusion: I-gel ® is better in terms of quicker insertion by anesthesia trainees than the Ambu Aura Gain™.

Are we closing the gap in faculty development needs for feedback training?

Pro: Integrated Five-Year Anesthesiology Residency Should Be Implemented Widely

Survey of Anesthesiology: June 2010 - Volume 54 - Issue 3 - p 108 doi: 10.1097/SA.0b013e3181dcb884

The Accreditation Council for Graduate Medical Education (ACGME) required that program directors receive 10-20 h/wk of protected time for program administration (including didactic teaching). In July 2022, this was reduced for all internal medicine subspecialties on the basis of program size, with 8 h/wk required for programs with fewer than seven fellows, the majority of nephrology programs. We surveyed all 151 US adult nephrology program directors (ACGME Public List of Programs 2021-2022) to determine how much protected time they receive, how much they think is necessary, and the division of their professional time. The anonymous 20-question online survey was administered from March 31 to April 30, 2022. The analysis was descriptive. Response rate was 66% (99 of 151). Geographic distribution and approved fellow positions were similar to programs nationally; 59% had fewer than seven approved positions. Median protected time was 10 h/wk (interquartile range, 5-10), with 8 h/wk (interquartile range, 5-10) for those with fewer than seven positions. Program directors estimated needing 12 h/wk (interquartile range, 10-16) to effectively administer programs, including those with fewer than seven positions, a median 5 h/wk (interquartile range, 0-7) more than received. Of program directors reporting <10 h/wk for program administration, 62% provided >20 hours of direct patient care. Thirty-nine percent had no protected time for core faculty. Fellow recruitment (68%) was the most time-consuming task, and didactic teaching (80%) was the most professionally rewarding. Approximately half of the nephrology programs surveyed were not in compliance with the ACGME-stipulated 10-h/wk minimum protected time for the 2021-2022 training year. Program directors estimated a median of 12 h/wk are needed to effectively manage programs.

Two-stage combined spinal epidural analgesia: a new paradigm for teaching obstetric anesthesia

Our scoping review aimed to provide an overview of the evidence on feedback for clinical education in anaesthesia and to identify opportunities for systematic review. The authors searched PubMed, Scopus and Web of Science databases from 2014 to 2023. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guideline, we independently screened titles, abstracts and full text for suitability based on predetermined inclusion and exclusion criteria. Our review encompassed all types of feedback studies specifically involving anaesthesia trainees. We collected data on various feedback contexts, such as task performance, processes, trainees' self-assessment, trainee-faculty relationships and residency programme-related endpoints. The search strategy identified 14 articles from two countries: n = 12 from the USA and n = 2 from Canada. Few studies (n = 4) reported different types of data provided automatically as feedback to the anaesthesia residents. We found that studies were conducted in different clinical contexts, including for residents' clinical performance, documentation and quality metrics (n = 4), feedback initiative (n = 1), feedback model (n = 1) and feedback agreement (n = 1). No meta-analysis would be suitable because we did not observe a continuous dependent variable in at least five studies. Feedback parameters and perception are variable during clinical supervision and training of anaesthesia residents. We found that several techniques and technological instruments are applied to facilitate feedback conversations. This scoping review shows that a systematic review can be performed for one topic involving anaesthesia trainee feedback, that is, the categories of information provided automatically to residents. Further research is required to confirm the applicability of our findings, specifically in other countries outside the USA and Canada.

To the Editor, We are grateful for the comments and interesting points raised by Dr. Craig in reference to our recent paper on substance abuse disorders in Canadian anesthesia departments. We purposely surveyed hospital site chiefs and residency program directors as our target responders. Although our decision resulted in a smaller overall survey size, our respondents were best positioned to represent our group of interest whilst avoiding duplicate reports of individuals affected by alcohol and substance abuse. Unfortunately, our study did suffer from a low response rate; at 48%, it does introduce a risk of nonresponse bias. The estimated incidence of alcohol and substance abuse amongst both trainees and attending anesthesiologists at academic centres thus forms a modest attempt at determining the true scope of the problem in anesthesiology. In our discussion, we draw comparisons with previously published surveys of substance abuse amongst anesthesia trainees and faculty. Although Dr. Craig refers to the report published by Warner et al. in 2013—work that forms a valuable contribution to the issue of substance abuse amongst anesthesia residents in North America— significant differences in methodology do not allow for a direct comparison with our findings. The aforementioned report does, however, bring two important points to the surface that we have raised in our paper and would like to re-emphasize. Firstly, the report highlights that such regulatory bodies as the American Board of Anesthesiology in North America can take ownership of substance abuse and its related problems through mandatory anonymous reporting of confirmed cases. Secondly, it forms an excellent example of the impact that formal data collection can have on furthering our understanding of the epidemiology of substance abuse amongst anesthesiologists. We agree with Dr. Craig that improvement in the reporting of both substance abuse cases and physician outcomes can be achieved only through concerted efforts from all stakeholders, both within and outside the specialty of anesthesiology.

Pleural Procedure Education in Fellowship: A National Survey of Program Directors

To investigate the experiences and opinions of programme directors, clinical supervisors and trainees on an in-training assessment (ITA) programme on a broad spectrum of competence for first year training in anaesthesiology. How does the programme work in practice and what are the benefits and barriers? What are the users' experiences and thoughts about its effect on training, teaching and learning? What are their attitudes towards this concept of assessment? Semistructured interviews were conducted with programme directors, supervisors and trainees from 3 departments. Interviews were audiotaped and transcribed. The content of the interviews was analysed in a consensus process among the authors. The programme was of benefit in making goals and objectives clear, in structuring training, teaching and learning, and in monitoring progress and managing problem trainees. There was a generally positive attitude towards assessment. Trainees especially appreciated the coupling of theory with practice and, in general, the programme inspired an academic dialogue. Issues of uncertainty regarding standards of performance and conflict with service declined over time and experience with the programme, and departments tended to resolve practical problems through structured planning. Three interrelated factors appeared to influence the perceived value of assessment in postgraduate education: (1) the link between patient safety and individual practice when assessment is used as a licence to practise without supervision rather than as an end-of-training examination; (2) its benefits to educators and learners as an educational process rather than as merely a method of documenting competence, and (3) the attitude and rigour of assessment practice.