Performance of Residents and Anesthesiologists in a Simulation-based Skill Assessment

Background Anesthesiologists and anesthesia residents are expected to acquire and maintain skills to manage a wide range of acute intraoperative anesthetic events. The purpose of this study was to determine whether an inventory of simulated intraoperative scenarios provided a reliable and valid measure of anesthesia residents' and anesthesiologists' skill. Methods Twelve simulated acute intraoperative scenarios were designed to assess the performance of 64 residents and 35 anesthesiologists. The participants were divided into four groups based on their training and experience. There were 31 new CA-1, 12 advanced CA-1, and 22 CA-2/CA-3 residents as well as a group of 35 experienced anesthesiologists who participated in the assessment. Each participant managed a set of simulated events. The advanced CA-1 residents, CA-2/CA-3 residents, and 35 anesthesiologists managed 8 of 12 intraoperative simulation exercises. The 31 CA-1 residents each managed 3 intraoperative scenarios. Results The new CA-1 residents received lower scores on the simulated intraoperative events than the other groups of participants. The advanced CA-1 residents, CA-2/CA-3 residents, and anesthesiologists performed similarly on the overall assessment. There was a wide range of scores obtained by individuals in each group. A number of the exercises were difficult for the majority of participants to recognize and treat, but most events effectively discriminated among participants who achieved higher and lower overall scores. Conclusion This simulation-based assessment provided a valid method to distinguish the skills of more experienced anesthesia residents and anesthesiologists from residents in early training. The overall score provided a reliable measure of a participant's ability to recognize and manage simulated acute intraoperative events. Additional studies are needed to determine whether these simulation-based assessments are valid measures of clinical performance.

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Simulation-based Assessment of Pediatric Anesthesia Skills

Anesthesiology ◽

10.1097/aln.0b013e318238bcf6 ◽

2011 ◽

Vol 115 (6) ◽

pp. 1308-1315 ◽

Cited By ~ 11

Author(s):

James J. Fehr ◽

John R. Boulet ◽

William B. Waldrop ◽

Rebecca Snider ◽

Megan Brockel ◽

...

Keyword(s):

Clinical Performance ◽

Improve Patient Safety ◽

Pediatric Anesthesia ◽

Clinical Exposure ◽

Wide Range ◽

Simulation Based ◽

Scenario Assessment ◽

Direct Measures ◽

Random Nature ◽

Anesthesia Residents

Background Assessment of pediatric anesthesia trainees is complicated by the random nature of adverse patient events and the vagaries of clinical exposure. However, assessment is critical to improve patient safety. In previous studies, a multiple scenario assessment provided reliable and valid measures of the abilities of anesthesia residents. The purpose of this study was to develop a set of relevant simulated pediatric perioperative scenarios and to determine their effectiveness in the assessment of anesthesia residents and pediatric anesthesia fellows. Methods Ten simulation scenarios were designed to reflect situations encountered in perioperative pediatric anesthesia care. Anesthesiology residents and fellows consented to participate and were debriefed after each scenario. Two pediatric anesthesiologists scored each scenario by key action checklist. The psychometric properties (reliability, validity) of the scores were studied. Results Thirty-five anesthesiology residents and pediatric anesthesia fellows participated. The participants with greater experience administering pediatric anesthetics generally outperformed those with less experience. Score variance attributable to raters was low, yielding a high interrater reliability. Conclusions A multiple-scenario, simulation-based assessment of pediatric perioperative care was designed and administered to residents and fellows. The scores obtained from the assessment indicated the content was relevant and that raters could reliably score the scenarios. Participants with more training achieved higher scores, but there was a wide range of ability among subjects. This method has the potential to contribute to pediatric anesthesia performance assessment, but additional measures of validity including correlations with more direct measures of clinical performance are needed to establish the utility of this approach.

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Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

Anesthesiology Research and Practice ◽

10.1155/2014/659160 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Ankeet D. Udani ◽

Alex Macario ◽

Kiruthiga Nandagopal ◽

Maria A. Tanaka ◽

Pedro P. Tanaka

Keyword(s):

Clinical Performance ◽

Mastery Learning ◽

Deliberate Practice ◽

Intervention Group ◽

Control Group ◽

Baseline Assessment ◽

Simulation Based ◽

Improved Performance ◽

Time Required ◽

Anesthesia Residents

Introduction.Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB.Methods.21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR).Results.Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03). The OR time required to perform SAB was not different between groups.Conclusions.The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

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Faculty Opinions recommendation of Performance of residents and anesthesiologists in a simulation-based skill assessment.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1097920.556061 ◽

2008 ◽

Author(s):

Jean Marty

Keyword(s):

Skill Assessment ◽

Simulation Based

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An Evaluation of Morphological Changes and Deformability of Suspended Red Blood Cells Prepared Using Whole Blood with Different Hemoglobin Levels of Tibetans

Transfusion Medicine and Hemotherapy ◽

10.1159/000513319 ◽

2021 ◽

pp. 1-10

Author(s):

Rui Zhong ◽

Dingding Han ◽

Xiaodong Wu ◽

Hong Wang ◽

Wanjing Li ◽

...

Keyword(s):

Red Blood Cells ◽

Whole Blood ◽

Blood Cells ◽

Morphological Changes ◽

Osmotic Fragility ◽

Spherical Shape ◽

Hypoxic Environment ◽

Wide Range ◽

Group A ◽

Cell Membrane Protein

Background: The hypoxic environment stimulates the human body to increase the levels of hemoglobin (HGB) and hematocrit and the number of red blood cells. Such enhancements have individual differences, leading to a wide range of HGB in Tibetans’ whole blood (WB). Study Design: WB of male Tibetans was divided into 3 groups according to different HGB (i.e., A: >120 but ≤185 g/L, B: >185 but ≤210 g/L, and C: >210 g/L). Suspended red blood cells (SRBC) processed by collected WB and stored in standard conditions were examined aseptically on days 1, 14, 21, and 35 after storage. The routine biochemical indexes, deformability, cell morphology, and membrane proteins were tested. Results: Mean corpuscular volume, adenosine triphosphate, pH, and deformability were not different in group A vs. those in storage (p > 0.05). The increased rate of irreversible morphology of red blood cells was different among the 3 groups, but there was no difference in the percentage of red blood cells with an irreversible morphology after 35 days of storage. Group C performed better in terms of osmotic fragility and showed a lower rigid index than group A. Furthermore, SDS-PAGE revealed similar cross-linking degrees of cell membrane protein but the band 3 protein of group C seemed to experience weaker clustering than that of group A as detected by Western Blot analysis after 35 days of storage. Conclusions: There was no difference in deformability or morphological changes in the 3 groups over the 35 days of storage. High HGB levels of plateau SRBC did not accelerate the RBC change from a biconcave disc into a spherical shape and it did not cause a reduction in deformability during 35 days of preservation in bank conditions.

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Reliability and Validity of a Simulation-based Acute Care Skills Assessment for Medical Students and Residents

Anesthesiology ◽

10.1097/00000542-200312000-00007 ◽

2003 ◽

Vol 99 (6) ◽

pp. 1270-1280 ◽

Cited By ~ 124

Author(s):

John R. Boulet ◽

David Murray ◽

Joe Kras ◽

Julie Woodhouse ◽

John McAllister ◽

...

Keyword(s):

Medical Students ◽

Acute Care ◽

Reliability And Validity ◽

Faculty Members ◽

First Year ◽

Clinical Experiences ◽

Critical Events ◽

Simulation Based ◽

Broad Domain ◽

Simulation Exercises

Background Medical students and residents are expected to be able to manage a variety of critical events after training, but many of these individuals have limited clinical experiences in the diagnosis and treatment of these conditions. Life-sized mannequins that model critical events can be used to evaluate the skills required to manage and treat acute medical conditions. The purpose of this study was to develop and test simulation exercises and associated scoring methods that could be used to evaluate the acute care skills of final-year medical students and first-year residents. Methods The authors developed and tested 10 simulated acute care situations that clinical faculty at a major medical school expects graduating physicians to be able to recognize and treat at the conclusion of training. Forty medical students and residents participated in the evaluation of the exercises. Four faculty members scored the students/residents. Results The reliability of the simulation scores was moderate and was most strongly influenced by the choice and number of simulated encounters. The validity of the simulation scores was supported through comparisons of students'/residents' performances in relation to their clinical backgrounds and experience. Conclusion Acute care skills can be validly and reliably measured using a simulation technology. However, multiple simulated encounters, covering a broad domain, are needed to effectively and accurately estimate student/resident abilities in acute care settings.

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Do Different Roles of Anesthesia Residents Improve Knowledge Retention after Non-Technical Skills Workshop?

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.09.12987 ◽

2021 ◽

Vol 104 (9) ◽

pp. 1519-1527

Keyword(s):

Test Scores ◽

Linear Regression Analysis ◽

Technical Skills ◽

Knowledge Retention ◽

University Hospital ◽

Multivariate Linear Regression Analysis ◽

Simulation Based ◽

Post Test ◽

Anesthesia Residents ◽

Predictors Of Change

Objective: The authors assessed whether anesthesia residents who acted as a scenario creators would have better knowledge retention than their juniors 90 days after participating in a simulation-based anesthetists’ non-technical skills (ANTS) workshop. Materials and Methods: A prospective observational study via simulation ANTS workshop was conducted at a university hospital in southern Thailand in November 2017. Seven third-year post-graduate (PGY-3) residents volunteered as scenario creators, while the remaining anesthesia residents were randomly selected to participate in or observe three case scenarios, which were cardiac arrest, hypotension, and difficult ventilation. Resident’s knowledge was assessed before, immediately after, and 90 days after the workshop using a 20-item multiple-choice questionnaire. Predictors of change in knowledge scores were analyzed using multivariate linear regression analysis and presented as beta coefficient (β) and 95% confidence limits (CL). Results: Twenty-four anesthesia residents were recruited in the present study and included eight PGY-1, seven PGY-2, and nine PGY-3. The roles consisted of seven scenario creators, seven participants, and 10 observers. The overall immediate post-test and 90-day post-test scores increased significantly compared to the pre-test scores with a mean of 15.5 and 13.2 versus 11.7 (p<0.001 and p=0.007, respectively). The predictors of change in 90-day scores were PGY-3 versus PGY-1 (β 95% CL 4.0 [0.5 to 7.6], p=0.039), and role of participants and observers versus scenario creator (β 95% CL 5.5 [2.2 to 8.8] and 6.7 [2.8 to 10.6], p=0.004, respectively). Conclusion: Anesthesia residents who were participants or observers could improve their knowledge 90 days after a simulation-based ANTS workshop without necessarily being a scenario creator. Keywords: Anesthetists’ non-technical skill; Knowledge retention; Scenario creator; Simulation workshop

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The Interned Soldiers of UРR Army at the Camp Stshalkovo in Poland (the Second Half of 1921 – the Beginning of 1922): the Moral and Life Conditions

Problems of World History ◽

10.46869/2707-6776-2017-4-13 ◽

2017 ◽

pp. 182-195

Author(s):

I. Sribnyak

Keyword(s):

Armed Forces ◽

Educational Work ◽

Material Resources ◽

Life Conditions ◽

Wide Range ◽

Red Army ◽

Group A ◽

Moral Condition ◽

The Government ◽

Destructive Processes

The article analyzes the moral condition and conditions of staying of interned Ukrainian soldiers in the camp of Stshalkovo (Poland) in the second half of 1921 – early 1922. Based on the use of a wide range of archival sources, the author concludes that the camp everyday life of the wartime period was marked by significant difficulties due to its extraordinary crowding and presence in the camp of interned and captured soldiers of other formations (Balahovtsy and Red Army soldiers). The lack of any material resources, the lack of adequate and high-quality food, the lack of fuel for heating booths, anti-Ukrainian agitation, led to the fact that a part of Ukrainian soldiers lost national moral values. In order to prevent the demoralization of Ukrainian warfare, the command of the group tried to intensify cultural and educational work in the camp, but due to lack of premises and lack of resources, it slowly collapsed. Some of the interned ones did not withstand the burden of hopeless and burdensome camping munitions, and left the camp in search of better living conditions. Obviously, this was a dangerous trend, and the command of the interned troops in various ways tried to prevent it from further spreading. The leader of the group A. Pиzitsky was particularly opposed to the destructive processes in the camp. His measures were fully understood and supported by the higher military leadership of the Armed Forces and the Government of the UPR.

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Analysis of virulence factors and emm typing of Streptococcus pyogenes clinical isolates.

10.7287/peerj.preprints.27649v1 ◽

2019 ◽

Author(s):

Gustavo Enck Sambrano ◽

Gustavo P Riboldi ◽

Keli C Reiter ◽

Thiago Galvão da Silva Paim ◽

Neidmar Correa Tolfo ◽

...

Keyword(s):

Virulence Factors ◽

Streptococcus Pyogenes ◽

Virulence Genes ◽

Clinical Isolates ◽

Pcr Analysis ◽

Tissue Tropism ◽

Factors Analysis ◽

Wide Range ◽

Group A ◽

Micro Organisms

Background: Streptococcus pyogenes, a Group A streptococci (GAS), is an important human pathogen that causes a wide range of infections. Methods: Twenty five clinical isolates of S. pyogenes were submitted to an emm typing and to a Real-time PCR analysis for 23 important virulence factors. Results: Fourteen emm types were found and the emm1 type was the most prevalent. The majority of the isolates were classified as emm pattern E, followed by A-C3. No pattern D was found. Among the virulence factors, the most prevalent were SpeG, Slo, C5a-peptidase and SPNA. Phage encoded virulence genes were also found among the strains, such as mf-2, SpeJ and SpeL. Discussion: The emm1 type was the most prevalent while the 13 others M types were distributed along the strains. No tissue tropism was found on the isolates. The virulence factors analysis demonstrated that chromosomally and phage-encoded genes were found, which confers a potential for high virulent micro-organisms.

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