How an Audit-and-Feedback-Based Educational Program Contributed to a Reduction in Environmentally Harmful Waste Anesthetic Gases Among Anesthesiology Residents
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SUBMITTER: Nordin E
PROVIDER: S-EPMC11234298 | biostudies-literature | 2024 Apr
REPOSITORIES: biostudies-literature
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Project description:Anesthesiology residents spend most of their training in operating rooms, but intraoperative teaching is often unstructured. Needs assessment indicated a need to incorporate a more evidence-based approach to education and improvement of our methods of introducing residents to primary anesthesiology literature. Kern's 6-step approach to curriculum development was used to create a robust and innovative curriculum to increase both the evidence-based component of our curriculum and the amount of educational intraoperative discussion among trainees and faculty. Our curriculum uses a structured topic outline, an e-journal club, and other relevant resources to facilitate discussion of the topics.
| S-EPMC7592885 | biostudies-literature
Project description:ImportanceSubstance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD.ObjectiveTo describe the incidence and outcomes of SUD among anesthesiology residents.Design, setting, and participantsRetrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44,612 residents contributing 177,848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively.Main outcomes and measuresCases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index.ResultsOf the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period.Conclusions and relevanceAmong anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.
| S-EPMC3993973 | biostudies-literature
Project description:Introduction:Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care. Methods:This simulation involved a 58-year-old man undergoing surgical debridement of a peripancreatic cyst with hemodynamic instability and septic shock. We conducted the simulation yearly for clinical anesthesia year 2 residents (n = 26) in 1-hour sessions with three to five learners at a time. The simulation covered the six Anesthesiology Milestones related to sepsis and septic shock as outlined in the Anesthesiology Milestones Project. Results:To date, 155 anesthesiology residents have completed the simulation. Commonly missed critical actions included failure to recognize the need for invasive lines, provide appropriate volumes of fluid resuscitation, inquire about blood cultures and antibiotics, and recognize the need for the patient to remain intubated. Most participants could appropriately diagnose and treat intraoperative septic shock, but all had moments of action or inaction to discuss and improve upon, and all learned from this scenario. Discussion:Simulation is an optimal way to practice the more rare and life-threatening clinical events in medicine. Even though septic shock is commonly managed in the ICU, it is relatively uncommon for it to develop acutely in the OR. This simulation is an effective and educational way to discuss the most recent sepsis/septic shock definition and review evidence-based guidelines for treatment.
| S-EPMC7083602 | biostudies-literature
Project description:IntroductionTransesophageal echocardiography (TEE) has become an important imaging modality for anesthesiologists to monitor and identify major cardiothoracic pathology in both noncardiac and cardiac surgical patients during the perioperative period. Knowledge in basic TEE sonoanatomy and the ability to obtain 11 basic views is a necessary foundation for junior residents so they may focus on using TEE as a monitor and tool to identify major cardiothoracic pathology later in their training.MethodsThe purpose of the rotation is to introduce TEE image acquisition to clinical anesthesia Year 1 (CA-1) and CA-2 residents. In this module, the anesthesiology resident is assigned to a specific TEE-week rotation in the cardiovascular center. There are three main components to our TEE curriculum: (1) web-based and simulator-based exposure to image acquisition and sonoanatomy, (2) intraoperative exposure to image acquisition and sonoanatomy, and (3) the 11 standard basic TEE views worksheet and assessment tool.ResultsUsing the 11 standard basic TEE views assessment tool, 100% of the residents who went through the curriculum were able to obtain at least nine of the 11 views without prompting. Forty-five percent (n = 5) of CA-1 were able to obtain all 11 views without prompting, while 58% of the CA-2s were able to obtain all 11 views without prompting.DiscussionThe preliminary results from our TEE curriculum are promising. We hope that this early exposure will lead to better learning on the residents' cardiac rotations in the CA-2 and CA-3 years by allowing them to start recognizing major pathology on TEE early on.
| S-EPMC6342386 | biostudies-literature
Project description:Transfusion medicine education for anesthesiology residents was an unmet need at our institution. Our goal was to develop a detailed and organized curriculum to introduce the essentials of transfusion medicine to first-year anesthesiology residents during a 3-week shared rotation. Based on our observations and the residents' feedback, the curriculum was modified after each year with the goal of creating a more resident-focused educational experience. Here, we report our 3-year experience of creating, teaching, and revising this curriculum to 35 residents, and we share our detailed curricula and learning aids (including over 100 directing questions for reading assignments) so that the interested reader can begin using them immediately.
| S-EPMC6572327 | biostudies-literature
Project description:BACKGROUND: The role of residents as teachers has grown over time. Programs have been established within various specialties to formally develop these skills. Anesthesiology residents are frequently asked to provide supervision for novice learners and have numerous opportunities for teaching skills and clinical decision making. Yet, there are no educational programs described in the literature to train anesthesiology residents to teach novice learners. OBJECTIVE: To explore whether a resident-as-teacher program would increase anesthesiology residents' self-reported teaching skills. METHODS: An 8-session interactive Anesthesiology Residents-as-Teachers (ART) Program was developed to emphasize 6 key teaching skills. During a 2-year period, 14 anesthesiology residents attended the ART program. The primary outcome measure was resident self-assessment of their teaching skills across 14 teaching domains, before and 6 months after the ART program. Residents also evaluated the workshops for quality with a 9-item, postworkshop survey. Paired t testing was used for analysis. RESULTS: Resident self-assessment led to a mean increase in teaching skills of 1.04 in a 5-point Likert scale (P < .001). Residents reported the greatest improvement in writing/using teaching objectives (+1.29, P < .001), teaching at the bedside (+1.57, P = .002), and leading case discussions (+1.64, P = .001). Residents rated the workshops 4.2 out of 5 (3.9-4.7). CONCLUSIONS: Residents rated their teaching skills as significantly improved in 13 of 14 teaching domains after participation in the ART program. The educational program required few resources and was rated highly by residents.
| S-EPMC3546586 | biostudies-other
Project description:Benchmarks have been established for the performance of six metal-organic frameworks (MOFs) and isoreticular MOFs (IRMOFs, which have the same underlying topology as MOF-5), MOF-5, IRMOF-3, MOF-74, MOF-177, MOF-199, and IRMOF-62, as selective adsorbents for eight harmful gases: sulfur dioxide, ammonia, chlorine, tetrahydrothiophene, benzene, dichloromethane, ethylene oxide, and carbon monoxide. Kinetic breakthrough measurements are used to determine the calculated dynamic adsorption capacity of each "benchmark" MOF for each gas. The capacity of each MOF is compared to that of a sample of Calgon BPL activated carbon. We find that pore functionality plays a dominant role in determining the dynamic adsorption performance of MOFs. MOFs featuring reactive functionality outperform BPL carbon in all but one case and exhibit high dynamic adsorption capacities up to 35% by weight.
| S-EPMC2575308 | biostudies-literature
Project description:BackgroundIn a flipped classroom approach, learners view educational content prior to class and engage in active learning during didactic sessions.ObjectiveWe hypothesized that a flipped classroom improves knowledge acquisition and retention for residents compared to traditional lecture, and that residents prefer this approach.MethodsWe completed 2 iterations of a study in 2014 and 2015. Institutions were assigned to either flipped classroom or traditional lecture for 4 weekly sessions. The flipped classroom consisted of reviewing a 15-minute video, followed by 45-minute in-class interactive sessions with audience response questions, think-pair-share questions, and case discussions. The traditional lecture approach consisted of a 55-minute lecture given by faculty with 5 minutes for questions. Residents completed 3 knowledge tests (pretest, posttest, and 4-month retention) and surveys of their perceptions of the didactic sessions. A linear mixed model was used to compare the effect of both formats on knowledge acquisition and retention.ResultsOf 182 eligible postgraduate year 2 anesthesiology residents, 155 (85%) participated in the entire intervention, and 142 (78%) completed all tests. The flipped classroom approach improved knowledge retention after 4 months (adjusted mean = 6%; P = .014; d = 0.56), and residents preferred the flipped classroom (pre = 46%; post = 82%; P < .001).ConclusionsThe flipped classroom approach to didactic education resulted in a small improvement in knowledge retention and was preferred by anesthesiology residents.
| S-EPMC5559245 | biostudies-literature
Project description:IntroductionThis activity is designed for midlevel and senior anesthesia trainees to experience the complexities of one-lung ventilation in pediatrics in a high-fidelity simulated environment. With the use of video-assisted thoracoscopic surgery (VATS) becoming increasingly common in pediatrics, we identified this area as an opportunity for the development of a dedicated educational simulation activity.MethodsOur simulated patient is a 3-year-old girl with empyema presenting for decortication via VATS who subsequently develops hypoxemia. The main challenges for the trainee include airway selection and insertion, lung isolation with fiber optic confirmation, and management of hypoxemia in the setting of one-lung ventilation. A pediatric medical simulator suitable for practicing resuscitation is required, and a tracheobronchial tree model is highly desirable. Basic knowledge of thoracic and pediatric anesthesia is required, but specific experience with pediatric lung isolation is not.ResultsLearners who experienced the content of this simulation expressed a strong sentiment of value. All pilot trainees were surveyed and indicated they either agree or strongly agree (4 or 5, respectively, on a 5-point Likert scale) that "This simulation enhanced my understanding of how to select lung isolation devices for pediatric patients" and "This simulation enhanced my understanding of how to manage hypoxia in context in one-lung ventilation." Comments were overall positive, including "I am better prepared to manage pediatric one lung ventilation cases."DiscussionAt the University of Iowa, this activity is part of a core curriculum of simulation training that resident physicians in anesthesiology experience during their training. It functions as a tool for education, evaluation, and self-identification of weaknesses in the learner's knowledge base as it relates to the perioperative management of pediatric one-lung ventilation, as well as for reinforcing material learned in the classroom and operating room. Numerous anesthesiology residents and faculty have pilot-tested this simulation, and necessary modifications have been made based on their feedback.
| S-EPMC6464470 | biostudies-literature
Project description:A new mechanochemical method was developed to convert polymer wastes, polyethylene (PE), polypropylene (PP), and polyvinyl chloride (PVC), to fuel gases (H2, CH4, and CO) under ball-milling with KMnO4 at room temperature. By using various solid-state characterizations (XPS, SEM, EDS, FTIR, and NMR), and density functional theory calculations, it was found that the activation followed the hydrogen atom transfer (HAT) mechanism. Two metal oxidant molecules were found to abstract two separate hydrogen atoms from the α-CH and β-CH units of substrates, [-βCH2-αCH(R)-]n, where R = H in PE, R = γCH3 in PP, and R = Cl in PVC, resulting in a di-radical, [-βCH•-αC•(R)-]. Subsequently, the two unpaired electrons of the di-radical were recombined into an alkene intermediate, [-βCH = αC(R)-], which underwent further oxidation to produce H2, CH4, and CO gases.
| S-EPMC8588166 | biostudies-literature