1
|
Ambardekar AP, Eriksen W, Ferschl MB, McNaull PP, Cohen IT, Greeley WJ, Lockman JL. A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study. Anesth Analg 2023; 136:437-445. [PMID: 35777829 DOI: 10.1213/ane.0000000000006128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric anesthesiology fellowship education has necessarily evolved since Accreditation Council for Graduate Medical Education (ACGME) accreditation in 1997. Advancements in perioperative and surgical practices, emerging roles in leadership, increasing mandates by accreditation and certification bodies, and progression toward competency-based education-among other things-have created pressure to enrich the current pediatric anesthesiology training system. The Society for Pediatric Anesthesia (SPA) formed a Task Force for Pediatric Anesthesiology Graduate Medical Education that included key leaders and subject matter experts from the society. A key element of the Task Force's charge was to identify curricular and evaluative enhancements for the fellowship program of the future. METHODS The Task Force executed a nationally representative, stakeholder-based Delphi process centered around a fundamental theme: "What makes a pediatric anesthesiologist?" to build consensus among a demographically varied and broad group of anesthesiologists within the pediatric anesthesiology community. A total of 37 demographically and geographically varied pediatric anesthesiologists participated in iterative rounds of open- and close-ended survey work between August 2020 and July 2021 to build consensus on the current state, known deficiencies, anticipated needs, and strategies for enhancing national educational offerings and program requirements. RESULTS Participation was robust, and consensus was almost completely achieved by round 2. This work generated a compelling Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis that suggests more strengths and opportunities in the current Pediatric Anesthesiology Graduate Medical Education program than weaknesses or threats. Stakeholders agreed that while fellows matriculate with some clinical knowledge and procedural gaps, a few clinical gaps exist upon graduation. Stakeholders agreed on 8 nonclinical domains and specific fundamental and foundational knowledge or skills that should be taught to all pediatric anesthesiology fellows regardless of career plans. These domains include (1) patient safety, (2) quality improvement, (3) communication skills, (4) supervision skills, (5) leadership, (6) medical education, (7) research basics, and (8) practice management. They also agreed that a new case log system should be created to better reflect modern pediatric anesthesia practice. Stakeholders further identified the need for the development of standardized and validated formative and summative assessment tools as part of a competency-based system. Finally, stakeholders noted that significant departmental, institutional, and national organizational support will be necessary to implement the specific recommendations. CONCLUSIONS A Delphi process achieved robust consensus in assessing current training and recommending future directions for pediatric anesthesiology graduate medical education.
Collapse
Affiliation(s)
- Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Whitney Eriksen
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marla B Ferschl
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Peggy P McNaull
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Ira T Cohen
- Division of Anesthesiology and Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's National, Washington, DC
| | - William J Greeley
- Departments of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Qian J, Rama A, Wang E, Wang T, Hess O, Khoury M, Jackson C, Caruso TJ. Assessing Pediatric Life Support Skills Using Augmented Reality Medical Simulation With Eye Tracking: A Pilot Study. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2022; 24:E691. [PMID: 36274998 PMCID: PMC9583759 DOI: 10.46374/volxxiv_issue3_qian] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Augmented reality (AR) and eye tracking are promising adjuncts for medical simulation, but they have remained distinct tools. The recently developed Chariot Augmented Reality Medical (CHARM) Simulator combines AR medical simulation with eye tracking. We present a novel approach to applying eye tracking within an AR simulation to assess anesthesiologists during an AR pediatric life support simulation. The primary aim was to explore clinician performance in the simulation. Secondary outcomes explored eye tracking as a measure of shockable rhythm recognition and participant satisfaction. METHODS Anesthesiology residents, pediatric anesthesiology fellows, and attending pediatric anesthesiologists were recruited. Using CHARM, they participated in a pediatric crisis simulation. Performance was scored using the Anesthesia-centric Pediatric Advanced Life Support (A-PALS) scoring instrument, and eye tracking data were analyzed. The Simulation Design Scale measured participant satisfaction. RESULTS Nine each of residents, fellows, and attendings participated for a total of 27. We were able to successfully progress participants through the AR simulation as demonstrated by typical A-PALS performance scores. We observed no differences in performance across training levels. Eye tracking data successfully allowed comparisons of time to rhythm recognition across training levels, revealing no differences. Finally, simulation satisfaction was high across all participants. CONCLUSIONS While the agreement between A-PALS score and gaze patterns is promising, further research is needed to fully demonstrate the use of AR eye tracking for medical training and assessment. Physicians of multiple training levels were satisfied with the technology.
Collapse
Affiliation(s)
- Jimmy Qian
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Asheen Rama
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Ellen Wang
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Tammy Wang
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Olivia Hess
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Michael Khoury
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Christian Jackson
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Thomas J. Caruso
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| |
Collapse
|
3
|
Watkins SC, de Oliveira Filho GR, Furse CM, Muffly MK, Ramamurthi RJ, Redding AT, Maass B, McEvoy MD. Tools for Assessing the Performance of Pediatric Perioperative Teams During Simulated Crises: A Psychometric Analysis of Clinician Raters' Scores. Simul Healthc 2021; 16:20-28. [PMID: 33956763 DOI: 10.1097/sih.0000000000000467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The pediatric perioperative setting is a dynamic clinical environment where multidisciplinary interprofessional teams interact to deliver complex care to patients. This environment requires clinical teams to possess high levels of complex technical and nontechnical skills. For perioperative teams to identify and maintain clinical competency, well-developed and easy-to-use measures of competency are needed. METHODS Tools for measuring the technical and nontechnical performance of perioperative teams were developed and/or identified, and a group of raters were trained to use the instruments. The trained raters used the tools to assess pediatric teams managing simulated emergencies. A psychometric analysis of the trained raters' scores using the different instruments was performed and the agreement between the trained raters' scores and a reference score was determined. RESULTS Five raters were trained and scored 96 recordings of perioperative teams managing simulated emergencies. Scores from both technical skills assessment tools demonstrated significant reliability within and between ratings with the scenario-specific performance checklist tool demonstrating greater interrater agreement than scores from the global rating scale. Scores from both technical skills assessment tools correlated well with the other and with the reference standard scores. Scores from the Team Emergency Assessment Measure nontechnical assessment tool were more reliable within and between raters and correlated better with the reference standard than scores from the BARS tool. CONCLUSIONS The clinicians trained in this study were able to use the technical performance assessment tools with reliable results that correlated well with reference scores. There was more variability between the raters' scores and less correlation with the reference standard when the raters used the nontechnical assessment tools. The global rating scale used in this study was able to measure the performance of teams across a variety of scenarios and may be generalizable for assessing teams in other clinical scenarios. The Team Emergency Assessment Measure tool demonstrated reliable measures when used to assess interprofessional perioperative teams in this study.
Collapse
Affiliation(s)
- Scott C Watkins
- From the Johns Hopkins All Children's Hospital (S.C.W.)St. Petersburg, FL; Federal University of Santa Catarina (G.R.d.O.F.), Florianópolis, Brazil; Medical University of South Carolina (C.M.F., A.T.R.), Charleston, SC; Stanford University Medical Center (M.K.M., R.J.R., B.M.), Palo Alto, CA; and Vanderbilt University Medical Center (M.D.M.), Nashville, TN
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Ambardekar AP, Black S, Singh D, Lockman JL, Simpao AF, Schwartz AJ, Hales RL, Rodgers DL, Gurnaney HG. The impact of simulation-based medical education on resident management of emergencies in pediatric anesthesiology. Paediatr Anaesth 2019; 29:753-759. [PMID: 31034728 DOI: 10.1111/pan.13652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Resident education in pediatric anesthesiology is challenging. Traditional curricula for anesthesiology residency programs have included a combination of didactic lectures and mentored clinical service, which can be variable. Limited pediatric medical knowledge, technical inexperience, and heightened resident anxiety further challenge patient care. We developed a pediatric anesthesia simulation-based curriculum to address crises related to hypoxemia and dysrhythmia management in the operating room as an adjunct to traditional didactic and clinical experiences. AIMS The primary objective of this trial was to evaluate the impact of a simulation curriculum designed for anesthesiology residents on their performance during the management of crises in the pediatric operating room. A secondary objective was to compare the retention of learned knowledge by assessment at the eight-week time point during the rotation. METHODS In this prospective, observational trial 30 residents were randomized to receive simulation-based education on four perioperative crises (Laryngospasm, Bronchospasm, Supraventricular Tachycardia (SVT), and Bradycardia) during the first week (Group A) or fifth week (Group B) of an eight-week rotation. Assessment sessions that included two scenarios (Laryngospasm, SVT) were performed in the first week, fifth week, and the eighth week of their rotation for all residents. The residents were assessed in real time and by video review using a 7-point checklist generated by a modified Delphi technique of senior pediatric anesthesiology faculty. RESULTS Residents in Group A showed improvement between the first week and fifth week assessment as well as between first week and eighth week assessments without decrement between the fifth week and eighth week assessments for both the laryngospasm and SVT scenarios. Residents in Group B showed improvement between the first week and eighth week assessments for both scenarios and between the fifth week and eighth week assessment for the SVT scenario. CONCLUSION This adjunctive simulation-based curriculum enhanced the learner's management of laryngospasm and SVT management and is a reasonable addition to didactic and clinical curricula for anesthesiology residents.
Collapse
Affiliation(s)
- Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - Stephanie Black
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Devika Singh
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan J Schwartz
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roberta L Hales
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David L Rodgers
- Clinical Simulation Center, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Harshad G Gurnaney
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|