Professionalization of anesthesiologists and critical care specialists in humanitarian action: a nationwide poll among italian residents

Residents working with Médecins Sans Frontières: training and pilot evaluation

Background

Well-prepared humanitarian workers are now more necessary than ever. Essential to the preparation process are: clearly defined learning objectives, curricula tailored to the nuances of humanitarian settings, simulation-based training, and evaluation. This manuscript describes a training program designed to prepare medical residents for their first field deployment with Médecins Sans Frontières and presents the results of a pilot assessment of its effectiveness.

Methods

The training was jointly developed by the Research Center in Emergency and Disaster Medicine- CRIMEDIM of the Università del Piemonte Orientale, Novara, Italy, and the humanitarian aid organization Médecins Sans Frontières- Italy (MSF-Italy); the following topics were covered: disaster medicine, public health, safety and security, infectious diseases, psychological support, communication, humanitarian law, leadership, and job-specific skills. It used a blended-learning approach consisting of a 3-month distance learning module; 1-week instructor-led coaching; and a field placement with MSF. We assessed its effectiveness using the first three levels of Kirkpatrick’s training evaluation model.

Results

Eight residents took part in the evaluation. Four were residents in emergency medicine, 3 in anesthesia, and 1 in pediatrics; 3 of them were female and the median age was 31 years. Two residents were deployed in Pakistan, 1 in Afghanistan, 1 in the Democratic Republic of Congo, 1 in Iraq, 2 in Haiti and 1 on board of the MSF Mediterranean search & rescue ship. Mean deployment time was 3 months. The average median score for the overall course was 5 (excellent). There was a significant improvement in post-test multiple choice scores (p = 0.001) and in residents’ overall performance scores (P = 0.000001).

Conclusion

Residents were highly satisfied with the training program and their knowledge and skills improved as a result of participation.

Trial registration

This study was approved by the Institutional Ethics Committee (date 24-02-2016, study code UPO.2015.4.10).

An Island-Wide Disaster Drill to Train the Next Generation of Anesthesiologists: The SIAARTI Academy Experience

OBJECTIVE

Anesthesiologists play a pivotal role in mass-casualty incidents management. Disaster medicine is part of the anesthesiologist's core skills; however, dedicated training is still scarce and, often, it does not follow a standardized program.

METHODS

We designed and delivered a crash course in disaster medicine for Italian anesthesiology residents participating in the nationwide program, Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) Academy Critical Emergency Medicine 2019. Residents totaling 145, from 39 programs, participated in a 75-minute workstation on the principles of disaster management. Following this, each participant was involved in a full-scale mass-casualty drill. A plenary debriefing followed to present simulation data, maximize feedback, and highlight all situations needing improvement.

RESULTS

Overall, participant performance was good: Triage accuracy was 85% prehospital and 84% in-hospital. Evacuation flow respected triage priority. During the debriefing, residents were very open to share and reflect on their experiences. A narrative qualitative analysis of the debriefing highlights that many participants felt overwhelmed by events during the exercise. Participants in coordination positions shared how they appreciated the need to switch from a clinical mindset to a managerial role.

CONCLUSION

This was an invaluable experience for anesthesiology trainees, providing them with the skill set to understand the fundamental principles of a mass-casualty response.

Comparing Resource Management Skills in a High- versus Low-Resource Simulation Scenario: A Pilot Study

BACKGROUND

Low-resource environments, such as those found in humanitarian crises, pose significant challenges to the provision of proper medical treatment. While the lack of training of health providers to such settings has been well-acknowledged in literature, there has yet to be any scientific evidence for this phenomenon.

METHODS

This pilot study utilized a randomized crossover experimental design to examine the effects of high- versus low-resource simulated scenarios of a resuscitation of a critically ill obstetric patient on a medical doctors' performance and inter-personal skills. Ten senior residents (fifth-year post-graduate) of the Maggiore Hospital School of Medicine (Novara, NO, Italy) were included in the study.

RESULTS

Overall performance score for the high-resource setting was 5.2, as opposed to only 2.3 for the low-resource setting. The mean effect size for the overall score was 2.9 (95% CI, 1.7-4.0; P <.001). The results suggest a significant decrease in both technical (medical) and non-technical skills, such as leadership, problem solving, situation awareness, resource utilization, and communication in the low-resource environment setting. The latter finding is of special important since it was yet to be reported.

CONCLUSIONS

This pilot study suggests that untrained physicians in low-resource environments may experience a considerable setback not only to their professional performance, but also to their interpersonal skills, when deployed ill-prepared to humanitarian missions. Consequently, this may endanger the health of local populations.

Humanitarian skill set acquisition trends among graduating US surgical residents, 2004-2014

BACKGROUND

Although interest in practicing surgery in resource-constrained settings is on the rise among graduating US surgical residents, there is ongoing debate about an optimal humanitarian skill set for surgeons who chose to work in such settings. In addition, increased emphasis on general surgery case exposure at the cost of specialty surgery case exposure has been documented and may have a negative impact on the breadth of resident training. Review of general surgery resident case logs to gauge experience in specialty surgery may provide insight into residents' readiness for work in resource-limited settings.

METHODS

We compared Accreditation Council for Graduate Medical Education general surgery resident case logs from 2004 to 2014 for operations thought to be essential for working in resource-constrained settings. These operations were chosen from published literature on this topic and authors' personal experience. Case numbers for specialty operations were compared by unpaired t-test analysis between the two periods.

RESULTS

Case averages in pediatric, genitourinary, and gynecologic surgery decreased significantly from 2004 to 2014 (range, 27%-46%). Orthopedic surgery case averages were unchanged, and plastic and general abdominal surgery case averages increased (range, 47%-50%).

CONCLUSIONS

Case mix among graduating US surgical residents has narrowed over the past 10 y. Resident experience in a variety of specialty fields, thought to be essential in resource-constrained settings, decreased markedly over the study period. Residents who intend to work in resource-constrained settings may need to craft individualized residency experiences or pursue postgraduate training in specialty surgery courses to best prepare for such work.

Professionalization of anesthesiologists and critical care specialists in humanitarian action: a nationwide poll among italian residents

BACKGROUND

Over the last decades, humanitarian crises have seen a sharp upward trend. Regrettably, physicians involved in humanitarian action have often demonstrated incomplete preparation for these compelling events which have proved to be quite different from their daily work. Responders to these crises have included an unpredictable mix of beginner-level, mid-level, and expert-level providers. The quality of care has varied considerably. The international humanitarian community, in responding to international calls for improved accountability, transparency, coordination, and a registry of professionalized international responders, has recently launched a call for further professionalization within the humanitarian assistance sector, especially among academic-affiliated education and training programs. As anesthetists have been involved traditionally in medical relief operations, and recent disasters have seen a massive engagement of young physicians, the authors conducted, as a first step, a poll among residents in Anesthesia and Critical Care Medicine in Italy to evaluate their interest in participating in competency-based humanitarian assistance education and in training incorporated early in residencies.

METHODS

The Directors of all the 39 accredited anesthesia/critical care training programs in Italy were contacted and asked to submit a questionnaire to their residents regarding the objectives of the poll study. After acceptance to participate, residents were enrolled and asked to complete a web-based poll.

RESULTS

A total of 29 (74%) of the initial training programs participated in the poll. Out of the 1,362 questionnaires mailed to residents, 924 (68%) were fully completed and returned. Only 63(6.8%) of the respondents voiced prior participation in humanitarian missions, but up to 690 (74.7%) stated they were interested in participating in future humanitarian deployments during their residency that carried over into their professional careers. Countrywide, 896 (97%) favored prior preparation for residents before participating in humanitarian missions, while the need for a specific, formal, professionalization process of the entire humanitarian aid sector was supported by 889 (96.2%).

CONCLUSIONS

In Italy, the majority of anesthesia/critical care residents, through a formal poll study, affirmed interest in participating in humanitarian assistance missions and believe that further professionalization within the humanitarian aid sector is required. These results have implications for residency training programs worldwide.