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McGraw R, Newbigging J, Blackmore E, Stacey M, Mercer C, Lam W, Braund H, Gilic F. Using cognitive load theory to develop an emergency airway management curriculum: the Queen's University Mastery Airway Course (QUMAC). CAN J EMERG MED 2023; 25:378-381. [PMID: 37133633 DOI: 10.1007/s43678-023-00495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 05/04/2023]
Abstract
Emergency airway management requires the simultaneous coordination of clinical reasoning and therapeutic interventions in the complex and time-sensitive setting of emergency resuscitation. The cognitive demand associated with these situations is invariably high and must be taken into consideration when designing training programs for this core professional competency. The four-component instructional design model (4C/ID), based on cognitive load theory, was used to develop a 1-year longitudinal airway management curriculum for Emergency Medicine residents. The simulation-based curriculum was designed with the goal of facilitating the construction and automation of schemas by individual residents in preparation for the high cognitive demand associated with emergency airway management in the clinical environment.
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Affiliation(s)
- Robert McGraw
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, USA.
| | - Joey Newbigging
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, USA
| | - Elizabeth Blackmore
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, USA
| | - Matthew Stacey
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, USA
| | - Colin Mercer
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, USA
| | - Wilson Lam
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Fil Gilic
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, USA
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Charoenkoop P, Luetrakool P, Puttapornpattana T, Sangdee N. Anesthesiology trainees performing flexible scope intubation in spontaneously breathing patients in the left lateral position and the supine position: a prospective randomized trial. BMC Anesthesiol 2022; 22:93. [PMID: 35366811 PMCID: PMC8976386 DOI: 10.1186/s12871-022-01636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Flexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions. Methods Forty patients aged 20 to 80 years with American Society of Anesthesiologists physical status class I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (Group S) or left lateral (Group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups. Results Patient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in Group L (10.5% vs. 85%; P < 0.01). Blood pressure and oxygen saturation declined in both groups after intubation. The relative risk of desaturation in patients in the left lateral position compared with the supine position was 0.44 (0.1649–1.1978). Conclusion The rate of successful flexible scope intubation on the first attempt and intubation time did not differ between the groups. The proportion of patients who required a jaw thrust maneuver was significantly lower in patients in the left lateral position. Trial registration https://www.thaiclinicaltrials.org/ (TCTR20200208001) on 08/02/2020.
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Leadership and teaching in airway management. Can J Anaesth 2021; 68:1317-1323. [PMID: 34231130 PMCID: PMC8260019 DOI: 10.1007/s12630-021-02057-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 01/15/2023] Open
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Dabbagh A, Elyassi H, Sabouri AS, Vahidshahi K, Ziaee SAM. The Role of Integrative Educational Intervention Package (Monthly ITE, Mentoring, Mocked OSCE) in Improving Successfulness for Anesthesiology Residents in the National Board Exam. Anesth Pain Med 2020; 10:e98566. [PMID: 32547933 PMCID: PMC7260396 DOI: 10.5812/aapm.98566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND National Board of Anesthesiology (NBA) pass rate is an important and critical step in clinical residency programs. OBJECTIVES This study was designed to assess the relationship between an integrative educational intervention (IEI) and the relative annual pass rate (RAPR). RAPR is defined as ratio of NBA pass rate of Shahid Beheshti University of Medical Sciences (SBMU) to the NBA pass rate of all the anesthesiology residency programs across Iran. METHODS In a descriptive-analytic retrospective study from 2012 to 2019, RAPR was calculated. IEI was implanted in the latter 4years period of this time interval includes: (1) individualized mentorship for residents by faculty members; (2) monthly in-training examination (ITE) in written; and (3) periodical mocked OSCE exam. Spearman's correlation coefficient was used to assess correlation between integrative educational intervention and RAPR results. P value less than 0.05 was considered statistically significant. RESULTS There was a statistically significant relationship between "integrative educational intervention program" and the RAPR results: Spearman's correlation coefficient = 0.655 (P value = 0.039). CONCLUSIONS The IEI package of Anesthesiology Department, SBMU showed a significant relationship with improvements in successfulness for anesthesiology residents in the National Board Exam (RAPR trend). More prolonged studies could prevail further aspects of these interventions.
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Affiliation(s)
- Ali Dabbagh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedayatollah Elyassi
- Anesthesiology Department, Anesthesiology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A. Sassan Sabouri
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Anesthesiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kourosh Vahidshahi
- Pediatric Cardiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chan JJ, Goy RW, Ithnin F, Sng BL. Difficult obstetric airway training: Current strategies, challenges and future innovations. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Abstract
An airway manager’s primary objective is to provide a path to oxygenation. This can be achieved by means of a facemask, a supraglottic airway, or a tracheal tube. If one method fails, an alternative approach may avert hypoxia. We cannot always predict the difficulties with each of the methods, but these difficulties may be overcome by an alternative technique. Each unsuccessful attempt to maintain oxygenation is time lost and may incrementally increase the risk of hypoxia, trauma, and airway obstruction necessitating a surgical airway. We should strive to optimize each effort. Differentiation between failed laryngoscopy and failed intubation is important because the solutions differ. Failed facemask ventilation may be easily managed with an supraglottic airway or alternatively tracheal intubation. When alveolar ventilation cannot be achieved by facemask, supraglottic airway, or tracheal intubation, every anesthesiologist should be prepared to perform an emergency surgical airway to avert disaster.
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Affiliation(s)
- Richard M. Cooper
- From the Department of Anesthesia, Faculty of Medicine, University of Toronto and University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Implementing Medical Technological Equipment in the OR: Factors for Successful Implementations. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:8502187. [PMID: 30245784 PMCID: PMC6136550 DOI: 10.1155/2018/8502187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Abstract
Operating rooms (ORs) more and more evolve into high-tech environments with increasing pressure on finances, logistics, and a not be neglected impact on patient safety. Safe and cost-effective implementation of technological equipment in ORs is notoriously difficult to manage, specifically as generic implementation activities omit as hospitals have implemented local policies for implementations of technological equipment. The purpose of this study is to identify success factors for effective implementations of new technologies and technological equipment in ORs, based on a systematic literature review. We accessed ten databases and reviewed included articles. The search resulted in 1592 titles for review, and finally 37 articles were included in this review. We distinguish influencing factors and resulting factors based on the outcomes of this research. Six main categories of influencing factors on successful implementations of medical equipment in ORs were identified: “processes and activities,” “staff,” “communication,” “project management,” “technology,” and “training.” We identified a seventh category “performance” referring to resulting factors during implementations. We argue that aligning the identified influencing factors during implementation impacts the success, adaptation, and safe use of new technological equipment in the OR and thus the outcome of an implementation. The identified categories in literature are considered to be a baseline, to identify factors as elements of a generic holistic implementation model or protocol for new technological equipment in ORs.
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Rochlen LR, Housey M, Gannon I, Mitchell S, Rooney DM, Tait AR, Engoren M. Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management. BMC Anesthesiol 2017; 17:96. [PMID: 28709415 PMCID: PMC5512836 DOI: 10.1186/s12871-017-0387-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND At many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents' familiarity with the content and correct adherence to the American Society of Anesthesiologists' Difficult Airway Algorithm (ASA DAA). METHODS Residents completed a pre-simulation multiple-choice survey measuring their understanding and use of the DAA. Residents then managed an emergent, difficult OOOR intubation in the simulation center, where two trained reviewers assessed performance using checklists. Post-simulation, the residents completed a survey rating their behaviors during the simulation. The primary outcome was comprehension and adherence to the DAA as assessed by survey responses and behavior in the simulation. RESULTS Sixty-three residents completed both surveys and the simulation. Post-survey responses indicated a shift toward decreased self-perceived familiarity with the DAA content compared to pre-survey responses. During the simulation, 22 (35%) residents were unsuccessful with intubation. Of these, 46% placed an LMA and 46% prepared for cricothyroidotomy. Nineteen residents did not attempt intubation. Of these, only 31% considered LMA placement, and 26% initiated cricothyroidotomy. CONCLUSIONS Many anesthesiology residency training programs permit resident autonomy in managing emergent intubations OOOR. Residents self-reported familiarity with the content of and adherence to the DAA was higher than that observed during the simulation. Curriculum focused on comprehension of the DAA, as well as improving communication with higher-level physicians and specialists, may improve outcomes during OOORs.
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Affiliation(s)
- Lauryn R Rochlen
- Department of Anesthesiology, University of Michigan, 1500 E. Medical Center Drive, 1H247 University Hospital, SPC 5048, Ann Arbor, MI, 48103, USA.
| | - Michelle Housey
- Department of Anesthesiology, University of Michigan, 2800 Plymouth Rd, NCRC, Bldg 16 G149S, Ann Arbor, MI, 48109, USA
| | - Ian Gannon
- Department of Anesthesiology, University of Michigan, 1500 E. Medical Center Drive, 1H247 University Hospital, SPC 5048, Ann Arbor, MI, 48103, USA
| | - Shannon Mitchell
- Department of Anesthesiology, University of Michigan, 1500 E. Medical Center Drive, 1H247 University Hospital, SPC 5048, Ann Arbor, MI, 48103, USA
| | - Deborah M Rooney
- Department of Learning Health Sciences, University of Michigan, G2400 Towsley Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5201, USA
| | - Alan R Tait
- Department of Anesthesiology, University of Michigan, 1500 E. Medical Center Drive, 1H247 University Hospital, SPC 5048, Ann Arbor, MI, 48103, USA
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, 1500 E. Medical Center Drive, 1H247 University Hospital, SPC 5048, Ann Arbor, MI, 48103, USA
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Weil G, Motamed C, Biau DJ, Guye ML. Learning curves for three specific procedures by anesthesiology residents using the learning curve cumulative sum (LC-CUSUM) test. Korean J Anesthesiol 2017; 70:196-202. [PMID: 28367291 PMCID: PMC5370306 DOI: 10.4097/kjae.2017.70.2.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures. METHODS The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation. RESULTS Overall, 27 (14-52), 19 (5-41), and 14 (6-33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP. CONCLUSIONS A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.
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Affiliation(s)
- Gregoire Weil
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
| | - David J Biau
- Department of Anesthesia, Institute Gustave Roussy, Villejuif, France
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Sainsbury JE, Telgarsky B, Parotto M, Niazi A, Wong DT, Cooper RM. The effect of verbal and video feedback on learning direct laryngoscopy among novice laryngoscopists: a randomized pilot study. Can J Anaesth 2016; 64:252-259. [DOI: 10.1007/s12630-016-0792-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/10/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
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Catalá Bauset JC, de Andres Ibañez JA, Valverde Navarro A, Martinez Soriano F. [Proposed difficult airway teaching methodology. Presentation of an interactive fresh frozen cadaver model]. ACTA ACUST UNITED AC 2014; 61:182-9. [PMID: 24556511 DOI: 10.1016/j.redar.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 10/22/2013] [Accepted: 11/05/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this paper is to present a methodology based on the use of fresh-frozen cadavers for training in the management of the airway, and to evaluate the degree of satisfaction among learning physicians. MATERIAL AND METHODS About 6 fresh-frozen cadavers and 14 workstations were prepared where participants were trained in the different skills needed for airway management. The details of preparation of the cadavers are described. The level of satisfaction of the participant was determined using a Likert rating scale of 5 points, at each of the 14 stations, as well as the overall assessment and clinical usefulness of the course. RESULTS The mean overall evaluation of the course and its usefulness was 4.75 and 4.9, out of 5, respectively. All parts of the course were rated above 4 out of 5. The high level of satisfaction of the course remained homogeneous in the 2 editions analysed. The overall satisfaction of the course was not finally and uniquely determined by any of its particular parts. CONCLUSION The fresh cadaver model for training physicians in techniques of airway management is a proposal satisfactory to the participant, and with a realism that approaches the live patient.
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Affiliation(s)
- J C Catalá Bauset
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - J A de Andres Ibañez
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - A Valverde Navarro
- Departamento de Anatomía y Embriología Humana, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
| | - F Martinez Soriano
- Departamento de Anatomía y Embriología Humana, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
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Abstract
In airway management, poor judgment, education and training are leading causes of patient morbidity and mortality. The traditional model of medical education, which relies on experiential learning in the clinical environment, is inconsistent and often inadequate. Curriculum change is underway in many medical organisations in an effort to correct these problems, and airway management is likely to be explicitly addressed as a clinical fundamental within any new anaesthetic curriculum. Competency-based medical education with regular assessment of clinical ability is likely to be introduced for all anaesthetists engaged in airway management. Essential clinical competencies need to be defined and improvements in training techniques can be expected based on medical education research. Practitioners need to understand their equipment and diversify their airway skills to cope with a variety of clinical presentations. Expertise stems from deliberate practice and a desire constantly to improve performance with a career-long commitment to education.
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Affiliation(s)
- P A Baker
- Department of Anaesthesiology, The University of Auckland, New Zealand.
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Crosby ET. An evidence-based approach to airway management: is there a role for clinical practice guidelines? Anaesthesia 2011; 66 Suppl 2:112-8. [PMID: 22074085 DOI: 10.1111/j.1365-2044.2011.06940.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Complications arising out of airway management represent an important cause of anaesthesia-associated morbidity and mortality. Anaesthetic practice itself can lead to preventable harm, a particular example being persistent attempts at direct laryngoscopy, that results in delay in employing alternative strategies (or devices) when intubation is difficult. When patients are injured, expert review is called upon and often concludes that airway management provided by the anaesthetists was substandard. Many training programmes do not offer their trainees structured or organised teaching in airway management and many trainees probably enter practice with limited skills to deal with difficult airways. The literature on the management of the difficult airway in anaesthesia practice (especially as it relates to new technology and salvage strategies) is expanding rapidly. New technologies and practised response algorithms may be helpful in the management of the difficult airway, reducing the potential for adverse patient outcomes. Specialist societies and national interest groups can play an important role by critically reviewing and then applying the evidence base to generate clinical practice guidelines. The recommendations contained in such guidelines should be based on the most current evidence and they should be reviewed regularly for their content and continued relevance.
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Affiliation(s)
- E T Crosby
- Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
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Philibert I. Review article: closing the research gap at the interface of learning and clinical practice. Can J Anaesth 2011; 59:203-12. [PMID: 22161270 DOI: 10.1007/s12630-011-9639-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 11/16/2011] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. PRINCIPAL FINDINGS Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a "research gap" where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. CONCLUSION Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.
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Affiliation(s)
- Ingrid Philibert
- Department of Field Activities, Accreditation Council for Graduate Medical Education and the Journal of Graduate Medical Education, Chicago, IL 60654, USA.
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Holak EJ, Kaslow O, Pagel PS. Who teaches surgical airway management and how do they teach it? A survey of United States anesthesiology training programs. J Clin Anesth 2011; 23:275-9. [DOI: 10.1016/j.jclinane.2010.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 09/28/2010] [Accepted: 10/10/2010] [Indexed: 11/16/2022]
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