Review article: Teaching, learning, and the pursuit of excellence in anesthesia education

Anesthesiologists' conceptions of learning anesthesia in the context of their specialty training program: a phenomenographic study

BACKGROUND

Training anesthesiologists poses challenges and complexities, particularly in defining and teaching excellence in anesthesia. Existing anesthesia curricula primarily emphasize the acquisition of knowledge, practical skills, and professional competencies, often neglecting the development of intangible skills like tacit knowledge. Despite efforts to establish learning goals through carefully describing competencies, there is a risk of oversimplifying the intricate aspects of professional anesthesia practice. Therefore, the objective of this study is to gain a deeper understanding of the genuine curriculum of a specialty training program in anesthesia. This will be achieved by exploring the perceptions of learners with different levels of experience within the program.

METHODS

This study employs a phenomenographic research approach to explore the conceptions of anesthesiology trainees and specialists, specifically from a student's perspective, regarding what constitutes an excellent anesthesiologist i.e., what to learn, and the learning process associated with it.

RESULTS

This study identified three different conceptions of learning anesthesia within the context of a specialty training program: "Learning Competencies of Anesthesia," "Learning Work as an Anesthesiologist" and "Learning Being an Anesthesiology Professional." These conceptions ranged from a relatively instrumental view of education and self-responsibility for learning to a perspective of continuous personal reflection and development integrated with professional interaction. The three conceptions can be described in six dimensions describing the variation in approach to learning and the conceptualization of an anesthesiologist. Relationships between the conceptions and the dimensions were represented in a descriptive framework, showing the hierarchy of increasing understanding.

CONCLUSION

This study has uncovered diverse learner perspectives among anesthesiologists at various experience levels concerning their understanding of the role of an anesthesiologist and the associated learning process. These distinct understandings can be categorized into different groups and presented in a descriptive framework that encapsulates the fundamental elements and important educational aspects of an anesthesiologist's progression through a specialty training program in anesthesia. By recognizing and integrating these diverse perspectives, anesthesia education can be enhanced, ultimately resulting in improved preparation of future anesthesia curriculum, teaching and assessments.

Cross-cultural adaptation and validation of the Spanish version of the Anesthetists' Non-Technical Skills (ANTS) assessment tool

STUDY OBJECTIVE

Establish the transcultural validity of Anesthetists Non-Technical Skills (ANTS) in a Spanish-speaking country.

DESIGN

Prospective cohort.

SETTING

Clinical simulation center.

SUBJECTS

Forty-two Anesthesia PY2 and PY3 residents participated in the study.

INTERVENTIONS

Four clinical scenarios simulating anesthesia crises were assessed with a Spanish version of ANTS. Every simulated scenario was run twice with a time span of 3 to 4 months between them.

MEASUREMENTS

Two anesthesiologists independently assessed all simulated sessions using ANTS. The ANTS indicators of construct validity were obtained by confirmatory factor analysis. Various goodness-of-fit indices of the factorial model were calculated: Comparative Fit Index (CFI); Tucker-Lewis Adjustment Index (TLI) and Root Mean Square Error of Approximation (RMSEA). The standardized factor loadings and the determination coefficient (R2) was also estimated.

MAIN RESULTS

A total of 212 clinical scenarios were analyzed. The specified factorial model had the same grouping of elements in four domains as the original version of ANTS. The CFI index and the TLI were 0.99 and the RMSEA reached 0.07 (95% CI 0.06-0.08). All the standardized factor loadings were found to be >0.4. Also, the elements obtained an R2 value that fluctuated between 0.54 and 0.92.

CONCLUSIONS

The Spanish version of ANTS is a valid, reliable and a useful tool to assess non-technical skills in Spanish-speaking countries. The applicability of the instrument was comparable to the original setting. The high reliability of ANTS in our setting allows us to propose its use not just in an educational and research setting; it can be used as an assessment tool of non-technical skills.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review

BACKGROUND

Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards.

METHODS

We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature.

RESULTS

We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers.

CONCLUSIONS

The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Experiences using an instrument for non-technical skills in nurse anaesthesia education: a focus group study

BACKGROUND

Although there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice.

METHODS

This study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach.

RESULTS

Six categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants' experiences with using the instrument: Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour. Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation. Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance.

CONCLUSION

Increased awareness of non-technical skills when using Nurse Anaesthetists' Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists' Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student's learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.

Simulation-based training following a theoretical lecture enhances the performance of medical students in the interpretation and short-term retention of 20 cross-sectional transesophageal echocardiographic views: a prospective, randomized, controlled trial

Background

Both simulation-based training and video-based training serve as educational adjuncts for learning TEE among medical students. In the present study, we hypothesized that simulation-based training would better enhance the performance of medical students in the interpretation of 20 cross-sectional views compared to video-based training.

Methods

A total of 120 4th-year undergraduate medical students were enrolled in the present study. The study began with a pre-test of all the participants, followed by a 90-min theoretical lecture and a post-test. Subsequently, the participants were randomly divided into the video-based group (Group V) and simulation-based group (Group S). Next, Group V received 60 min of TEE video learning, while Group S received 60 min of TEE simulator training. After the respective training, both the groups undertook the retention-test 1 and retention-test 2, 1 week and 1 month later, respectively. The performance for each test was evaluated by five views, which were selected randomly and, respectively, from a set of 20 cross-sectional views. The primary outcome was the performance of the retention-test 1. Secondary outcomes included: (1) comparison the performances of the pre-test, post-test, and retention-test 2 between two groups; (2) comparison the performances of pre-test and post-test in the same group; (3) comparison the performances of retention-test 1, and retention-test 2 in the same group.

Results

Better performances were observed in Group S in both retention-test 1 (Group V: 63.2 [52.6, 77.6] vs. Group S: 89.5 [68.4, 100.0], P < 0.001) and retention-test 2 (Group V: 58.0 [48.0, 72.0] vs. Group S: 74.0 [64.0, 80.0], P < 0.001) compared to Group V. No statistically significant differences were observed in the performances of pre-test (Group V: 8.3 [4.2, 12.5] vs. Group S: 8.3 [4.2, 12.5], P = 0.825) or post-test (Group V: 46.2 [38.5, 57.7] vs. Group S: 44.2 [38.5, 56.7], P = 0.694) between the two groups. The improvement had been observed in the post-test, compared with pre-test in the same group, respectively (Group V in post-test: 46.2 [38.5, 57.7] vs. Group V in pre-test: 8.3 [4.2, 12.5], P < 0.001; Group S in post-test: 44.2 [38.5, 56.7] vs. Group S in pre-test: 8.3 [4.2, 12.5], P < 0.001). However, the performance in retention-test 2 was significantly reduced, compared with retention-test 1 in the same group, respectively (Group V in retention-test 2: 58.0 [48.0, 72.0] vs. Group V in retention-test 1: 63.2 [52.6, 77.6] P = 0.005; Group S in retention-test 2: 74.0 [64.0, 80.0] vs. Group S in retention-test 1: 89.5 [68.4, 100.0], P < 0.001).

Conclusions

Following a 90-min theoretical lecture, simulation-based training better enhanced the performance of medical students in the interpretation and short-term retention of 20 cross-sectional views compared to video-based training.

Trial registration

http://www.chictr.org.cn (ChiCTR2000033519, 3/June/2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-021-02753-1.

Psychometric Testing of a Structured Assessment Instrument for Non-technical Skills (NANTS-no) for Use in Clinical Supervision of Student Nurse Anesthetists

BACKGROUND

This study evaluated psychometric properties of a structured behavioral assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no). It estimated whether reliable assessments of nontechnical skills (NTS) could be made after taking part in a workshop. An additional objective was to evaluate the instrument's acceptability and usability.

METHODS

An explorative design was used. Nurse anesthetists (n = 46) involved in clinical supervision attended a 6-hour workshop on NTS, then rated NTS in video-recorded simulated scenarios and completed a questionnaire.

RESULTS

High reliability and dependability were estimated in this setting. Participants regarded the instrument as useful for clinical supervision of student nurse anesthetists (SNAs).

CONCLUSIONS

Findings suggest that NANTS-no may be reliable for performing clinical assessments of SNAs and encouraging critical reflection. However, further research is needed to explore its use in clinical settings.

Enhancing Educational Scholarship Through Conceptual Frameworks: A Challenge and Roadmap for Medical Educators

Historically, health sciences education has been guided by tradition and teacher preferences rather than by the application of practices supported by rigorous evidence of effectiveness. Although often underutilized, conceptual frameworks-theories that describe the complexities of educational and social phenomenon-are essential foundations for scholarly work in education. Conceptual frameworks provide a lens through which educators can develop research questions, design research studies and educational interventions, assess outcomes, and evaluate the impact of their work. Given this vital role, conceptual frameworks should be considered at the onset of an educational initiative. Use of different conceptual frameworks to address the same topic in medical education may provide distinctive approaches. Exploration of educational issues by employing differing, theory-based approaches advances the field through the identification of the most effective educational methods. Dissemination of sound educational research based on theory is similarly essential to spark future innovation. Ultimately, this rigorous approach to medical education scholarship is necessary to allow us to establish how our educational interventions impact the health and well-being of our patients.

Exploring anesthesiologists' understanding of situational awareness: a qualitative study

PURPOSE

This study explored how anesthesiologists understand situational awareness (SA) and how they think SA is learned, taught, and assessed.

METHODS

Semi-structured interviews were performed with practicing anesthesiologists involved in teaching. This qualitative study was conducted using constructivist grounded theory techniques (i.e., line-by-line coding, memoing, and constant comparison) in a thematic analysis of interview transcripts. Group meetings were held to develop and review themes emerging from the data.

RESULTS

Eighteen anesthesiologists were interviewed. Respondents displayed an understanding of SA using a mixture of examples from clinical experience and everyday life. Despite agreeing on the importance of SA, formal definitions of SA were lacking, and the participants did not explicate the topic of SA in either their practice or their teaching activities. Situational awareness had been learned informally through increasing independence in the clinical context, role modelling, reflection on errors, and formally through simulation. Respondents taught SA through modelling and discussing scanning behaviour, checklists, verbalization of thought processes, and debriefings. Although trainees' understanding of SA was assessed as part of the decision-making process for granting clinical independence, respondents found it difficult to give meaningful feedback on SA to their trainees.

CONCLUSION

Although SA is an essential concept in anesthesiology, its use remains rather tacit, primarily due to the lack of a common operational definition of the term. Faculty development is required to help anesthesiologists teach and assess SA more explicitly in the clinical environment.

The "educational alliance" as a framework for reconceptualizing feedback in medical education

Feedback has long been considered a vital component of training in the health professions. Nonetheless, it remains difficult to enact the feedback process effectively. In part, this may be because, historically, feedback has been framed in the medical education literature as a unidirectional content-delivery process with a focus on ensuring the learner's acceptance of the content. Thus, proposed solutions have been organized around mechanistic, educator-driven, and behavior-based best practices. Recently, some authors have begun to highlight the role of context and relationship in the feedback process, but no theoretical frameworks have yet been suggested for understanding or exploring this relational construction of feedback in medical education. The psychotherapeutic concept of the "therapeutic alliance" may be valuable in this regard.In this article, the authors propose that by reorganizing constructions of feedback around an "educational alliance" framework, medical educators may be able to develop a more meaningful understanding of the context-and, in particular, the relationship-in which feedback functions. Use of this framework may also help to reorient discussions of the feedback process from effective delivery and acceptance to negotiation in the environment of a supportive educational relationship.To explore and elaborate these issues and ideas, the authors review the medical education literature to excavate historical and evolving constructions of feedback in the field, review the origins of the therapeutic alliance and its demonstrated utility for psychotherapy practice, and consider implications regarding learners' perceptions of the supervisory relationship as a significant influence on feedback acceptance in medical education settings.