Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

Background  The Accreditation Council for Graduate Medical Education establishes minimum case requirements for trainees. In the subspecialty of obstetric anesthesiology, requirements for fellow participation in nonobstetric antenatal procedures pose a particular challenge due to the physical location remote from labor and delivery and frequent last-minute scheduling. Objectives  In response to this challenge, we implemented an informatics-based notification system, with the aim of increasing fellow participation in nonobstetric antenatal surgeries. Methods  In December 2014 an automated email notification system to inform obstetric anesthesiology fellows of scheduled nonobstetric surgeries in pregnant patients was initiated. Cases were identified via daily automated query of the preoperative evaluation database looking for structured documentation of current pregnancy. Information on flagged cases including patient medical record number, operating room location, and date and time of procedure were communicated to fellows via automated email daily. Median fellow participation in nonobstetric antenatal procedures per quarter before and after implementation were compared using an exact Wilcoxon-Mann-Whitney test due to low baseline absolute counts. The fraction of antenatal cases representing nonobstetric procedures completed by fellows before and after implementation was compared using a Fisher''s exact test. Results  The number of nonobstetric antenatal cases logged by fellows per quarter increased significantly following implementation, from median 0[0,1] to 3[1,6] cases/quarter ( p  = 0.007). Additionally, nonobstetric antenatal cases completed by fellows as a percentage of total antenatal cases completed increased from 14% in preimplementation years to 52% in postimplementation years ( p  < 0.001). Conclusion  Through an automated email system to identify nonobstetric antenatal procedures in pregnant patients, we were able to increase the number of these cases completed by fellows during 3 years following implementation.     

Randomized Controlled Simulation Trial to Compare Transfer Procedures for Emergency Cesarean

ObjectiveTo test the hypothesis that capping intravenous and epidural lines would reduce time to transfer women in labor to the operating room and time to readiness for general anesthesia for emergency cesarean. The secondary purpose was to identify latent threats to patient safety.DesignMixed methods analysis of a randomized, controlled, in situ simulation trial.SettingLabor and delivery unit at high-risk referral center.ParticipantsFifteen interprofessional teams that included labor and delivery nurses and anesthesiology residents.MethodsImmediately before simulation, we randomized bedside nurses and anesthesiology residents to one of two groups: usual transfer or the cap and run procedure. Simulation scenarios started with fetal heart rate decelerations that necessitated position changes followed by emergency cesarean. An embedded simulated obstetrician announced the decision for cesarean; completion of an OR checklist confirmed team readiness to induce general anesthesia. Postsimulation debriefing was focused on teamwork and opportunities to improve safety, and we used qualitative analysis to synthesize results.ResultsWe found no statistically significant difference in the overall time from decision for cesarean to readiness for general anesthesia between the two groups (usual transfer median = 445 seconds [interquartile range, 425–465] vs. cap and run 390 seconds [interquartile range, 383–443], p = .12). The time in the operating room was less in the cap and run group than in the usual transfer group (median = 300 seconds vs. 250 seconds, p = .038). Qualitative analysis of the debriefing data indicated advantages of the capping procedure, including better bed maneuverability and fewer tangled lines.ConclusionWe found no evidence of decreased overall time from decision for cesarean to readiness for general anesthesia based on whether the nurse capped the intravenous and epidural lines or pushed the intravenous pole alongside the bed. However, nurses perceived improved patient safety with the cap and run procedure.     

Seminar教学在麻醉学住院医师培训中的应用

Seminar是培养麻醉学住院医师独立思维及科研能力的一种有效的教学方法。通过简要介绍seminar教学的基本概念,讨论了seminar教学在麻醉学住院医师培训中的应用及其意义。seminar教学在培养麻醉学住院医师主动探索和学习知识,加深对麻醉学基本理论知识的理解及提高其综合素质等方面都具有促进作用。     

麻醉科进修医生导师制的建立与探讨

根据工作性质和进修医生的特点,北京协和医院麻醉科在进修医生教学中引入导师制。该教学模式增强了带教教师的责任感和进修医生的归属感,通过针对性教学有效提高了进修医生的整体素质,为临床麻醉质量和患者临床安全提供了保障。导师制明确和强化了导师和进修医生之间的关系,是适合麻醉科进修医生培训的有效模式。     

现代网络技术在临床麻醉学教学中的应用研究

以临床麻醉学精品课程网站为平台,建立临床麻醉学网络教学平台,以培养复合型临床麻醉学人才为目标,对我院临床麻醉教学进行教学改革,营建了新的网络教学平台,创造了新的教学空间和教学环境,充分的调动了学生的学习热情、积极性和主动性,达到了良好的教学效果。     

设置麻醉学专业体外循环学方向五年制本科教育的思考

在我国高等医学教育领域中设置麻醉学专业体外循环学方向五年制本科教育尚属首次。本文就在麻醉学中设置体外循环学方向本科教育的必要性、迫切性和体外循环学方向本科教育的培养目标以及课程体系进行了论证,并对创设体外循环学方向本科教育提出建议。     

Training needs and qualifications of anaesthesiologists not exposed to ALS

Objectives: To establish which needs exist for specific training in Advanced Cardiac Life Support (ALS) in anaesthesiology residents and interns not exposed to structured ALS courses. Methods: 48 residents, and seven interns accepted for training in anaesthesiology, were tested in a spontaneous, blind, cross-sectional, prospective assessment using a recording manikin with validated scoring system, a questionnaire, and 35 multiple-choice questions. Results: 65% admitted not having had any CPR training within the last 2 years. The answers were correct in 55±14% of the cases, increasing significantly with the length of training (P=0.001). One-rescuer CPR skills were inadequate: only 13% (n=7) of participants scored within acceptable limits when using the Berden Scoring system (Berden et al., Resuscitation 1992;13:31–41), which assigned weighted error points to BLS skills. No correlation with skill was noted with increased length of residency, confidence, ER or ICU experience, or participation in CPR-incidents. Conclusions: anaesthesiology residents and interns were not able to demonstrate BLS skills properly even while in training and did not recognize this themselves. CPR-related knowledge is poor and increases only incidentally over the years of residency even though participants were frequently confronted with seminars and resuscitation situations, and see protocols daily. The use of multiple-choice questions and the Berden scoring system avoids difficulties in evaluating case-scenario type of tests. We suggest that trainees are motivated to take part in standardized, intensive, recognised ALS courses which emphasize BLS skills and require (re)certification.     

Professional artist,good Samaritan,servant and co-ordinator: four ways of understanding the anaesthetist's work

Background: Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work. Methods: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed. Results: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly. Conclusions: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.     

部分麻醉书籍的插图标注错误

在经口气管内捕管过程中，当患者的口轴、咽轴及喉轴线接近重叠时，便于插入气管导管。一些书籍的插图对呼吸道三轴线标注错误。错误的插图不利于读者理解呼吸道三轴线的解剖学特点，不利于指导气管捕管操作，应该得到纠正。呼吸道三轴线的位置关系，可以应用于气道评估和确立个体化的插管体位。