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Spijkerman S, Manning DM, Green-Thompson LP. Undergraduate Anesthesia Skills for a Global Surgery Agenda: Students' Self-Reported Competence. Anesth Analg 2024; 138:616-625. [PMID: 36888537 DOI: 10.1213/ane.0000000000006375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Safe anesthesia is imperative for the Global Surgery agenda and Sustainable Development Goal 3. Due to a shortage of specialists in South Africa (SA), anesthetic services are often provided by nonspecialist doctors, often newly qualified and frequently without immediate supervision. The burden of disease in the developing world demands fit-for-purpose, day-one medical graduates. Although undergraduate anesthesia training is mandatory for medical students in SA, no outcomes are specified, and these are decided autonomously at each medical school. This study describes the current self-perceived anesthetic competence of medical students in SA as a needs assessment directed at achieving the goals of Global Surgery in SA and other developing countries. METHODS In this cross-sectional observational study, 1689 students (89% participation rate), representing all medical schools in SA, rated their self-perceived competence at graduation in 54 anesthetic-related Likert scale items in 5 themes: patient evaluation, patient preparation for anesthesia, practical skills performance, administration of anesthesia, and the management of intraoperative complications. Medical schools were divided into clusters A (≥25 days of anesthetic training) and B (<25 days). Descriptive statistics, Fisher exact test, and a mixed-effects regression model were used in the statistical analysis. RESULTS Students felt more prepared for history-taking and patient examination than for managing emergencies and complications. The self-perceived competence of students at cluster A schools was higher across all 54 items and all 5 themes. The same was observed for general medical skills and skills relating to maternal mortality in SA. CONCLUSIONS Time-on-task, capacity for repetition, and student maturity might have impacted self-efficacy and should be considered in curriculum development. Students felt less prepared for emergencies. Focused training and assessment aimed at emergency management should be considered. Students did not feel competent in general medical areas, in which anesthetists are experts, including resuscitation, fluid management, and analgesia. Anesthetists should take ownership of this training at the undergraduate level. Cesarean delivery is the most performed surgical procedure in sub-Saharan Africa. The Essential Steps in Managing Obstetric Emergencies (ESMOE) program was designed for internship training but can be introduced at undergraduate level. This study suggests that curriculum reform is required. The achievement of an agreed-upon set of standardized national undergraduate anesthetic competencies may ensure fit-for-purpose practitioners. Undergraduate and internship training should align to form part of a continuum of basic anesthetics training in SA. The findings of this study might benefit curriculum development in other regions with similar contexts.
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Hamilton J, McCarroll K, Kisiel LM, Jagger K, Boulet L. A survey of Canadian specialist anesthesiologists and family practice anesthetists: rural operating room use, a mixed model of care, and mentoring. Can J Anaesth 2024:10.1007/s12630-024-02708-2. [PMID: 38413517 DOI: 10.1007/s12630-024-02708-2] [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: 06/12/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 02/29/2024] Open
Abstract
PURPOSE The aim of this project was to collect data on the delivery of anesthesia in Canada. Specifically, our goal was to increase knowledge by identifying provider demographics and different models of anesthesia delivery, and to explore relationships among specialist anesthesiologists (SAs) and family practice anesthetists (FPAs) with a focus on mentoring. METHODS An online questionnaire was circulated to SAs and FPAs holding membership with the Canadian Anesthesiologists' Society or the Society of Rural Physicians of Canada. A total of 274/2,578 individuals completed the survey (170 SAs and 104 FPAs), providing a response rate of 10.6%. The survey included questions about demographics, anesthesia training, anesthesia resources, models of care, and mentoring relationships. RESULTS Three major themes emerged from the data: 1) FPAs and rural operating rooms are underused resources as 65% (64/98) of FPAs reported having capacity to increase their individual volume of anesthesia services and 41% (40/98) thought capacity existed within their hospital to increase the volume of surgery; 2) 20 hospitals employed a mixed model of anesthesia care whereby SAs and FPAs worked collectively within the same site; providers working within this model reported high levels of satisfaction and independence; 3) most SAs and FPAs perceived a benefit to mentoring and were interested in participating in a mentoring program. CONCLUSION This survey shows perceived capacity to expand surgical services in rural areas, a precedent for a mixed SA-FPA model of anesthesia delivery at the same site, and desire for anesthesia providers to engage in mentoring. Such options should be considered to strengthen the physician-led anesthesiology profession in Canada.
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Affiliation(s)
- Jordan Hamilton
- Shuswap Lake General Hospital, 601 10th Street NE, Salmon Arm, BC, V1E 4A7, Canada.
| | | | - Luz Maria Kisiel
- Department of Physician Quality Improvement and Department of Medical Imaging, Interior Health Authority, Kelowna, BC, Canada
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Gilchrist PT, Beaton NSM, Atkin JN, Roberts LJ. The new Diploma of Rural Generalist Anaesthesia: Supporting Australian rural and remote communities. Anaesth Intensive Care 2024; 52:6-15. [PMID: 38006613 DOI: 10.1177/0310057x231196909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios.
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Affiliation(s)
- Peter T Gilchrist
- Flinders and Upper North Local Health Network, Whyalla, Australia
- Rural Generalist Program, South Australia Health, Adelaide, Australia
- Royal Australian College of General Practitioners, East Melbourne, Australia
- Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Neil St M Beaton
- Australian College of Rural and Remote Medicine, Brisbane, Australia
- James Cook University College of Medicine and Dentistry, Townsville, Australia
| | | | - Lindy J Roberts
- Australian and New Zealand College of Anaesthetists, Melbourne, Australia
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Percy S, Sahi S, Bua E, Shamasunder S, Lipnick M, Law T. Living the work: the HEAL Initiative as a model for perioperative health workforce transformation and health equity work. Can J Anaesth 2023; 70:968-971. [PMID: 37217737 PMCID: PMC10202527 DOI: 10.1007/s12630-023-02451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 05/24/2023] Open
Affiliation(s)
- Samuel Percy
- Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
| | - Saad Sahi
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuel Bua
- Department of Surgery, Busitema University, Mbale, Tororo, Uganda
| | - Sriram Shamasunder
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Tyler Law
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
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Bello CM, Mackert S, Harnik MA, Filipovic MG, Urman RD, Luedi MM. Shared Decision-Making in Acute Pain Services. Curr Pain Headache Rep 2023; 27:193-202. [PMID: 37155131 DOI: 10.1007/s11916-023-01111-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE OF REVIEW The implementation of shared decision-making (SDM) in acute pain services (APS) is still in its infancies especially when compared to other medical fields. RECENT FINDINGS Emerging evidence fosters the value of SDM in various acute care settings. We provide an overview of general SDM practices and possible advantages of incorporating such concepts in APS, point out barriers to SDM in this setting, present common patient decisions aids developed for APS and discuss opportunities for further development. Especially in the APS setting, patient-centred care is a key component for optimal patient outcome. SDM could be included into everyday clinical practice by using structured approaches such as the "seek, help, assess, reach, evaluate" (SHARE) approach, the 3 "MAking Good decisions In Collaboration"(MAGIC) questions, the "Benefits, Risks, Alternatives and doing Nothing"(BRAN) tool or the "the multifocal approach to sharing in shared decision-making"(MAPPIN'SDM) as guidance for participatory decision-making. Such tools aid in the development of a patient-clinician relationship beyond discharge after immediate relief of acute pain has been accomplished. Research addressing patient decision aids and their impact on patient-reported outcomes regarding shared decision-making, organizational barriers and new developments such as remote shared decision-making is needed to advance participatory decision-making in acute pain services.
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Affiliation(s)
- Corina M Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland.
| | - Simone Mackert
- Department of Anaesthesiology Spital Grabs, Spitalregion Rheintal Werdenberg Sarganserland, Spitalstrasse 44, Grabs, St. Gallen, 9472, Switzerland
| | - Michael A Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland
| | - Mark G Filipovic
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland
| | - Richard D Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland
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Simkin S, Orser BA, Wilson CR, Bourgeault IL. The anesthesia workforce in Canada: a methodology to identify physician anesthesia providers using health administrative data. HUMAN RESOURCES FOR HEALTH 2023; 21:34. [PMID: 37101289 PMCID: PMC10134661 DOI: 10.1186/s12960-023-00820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/16/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Safe and timely anesthesia services are an integral component of modern health care systems. There are, however, increasing concerns about the availability of anesthesia services in Canada. Thus, a comprehensive approach to assess the capacity of the anesthesia workforce to provide service is a critical need. Data regarding the anesthesia services provided by specialists and family physicians are available through the Canadian Institute for Health Information (CIHI) but collating the data across delivery jurisdictions has proven challenging. As a result, information related to the activity of physician anesthesia providers is routinely excluded from annual physician workforce reports. Our goal was to develop a novel approach to identifying and characterizing the anesthesia workforce on a pan-Canadian scale. METHODS The study was approved by the University of Ottawa Office of Research Ethics and Integrity. We developed a methodology to identify physicians who provided anesthesia services in Canada between 1996 and 2018 using data elements from the CIHI National Physician Database. We iteratively consulted with expert advisors and compared the results with Scott's Medical Database, the Canadian Medical Association (CMA) Masterfile, and the College of Family Physicians of Canada membership database. RESULTS The methodology identified providers of anesthesia services using data elements from the CIHI National Physician Database, including categories of the National Grouping System, specialty designations, activity levels and participation thresholds. Physicians who provided anesthesia services only sporadically and medical residents-in-training were excluded. This methodology produced estimates of anesthesia providers that aligned with other sources. The process we followed was sequential, transparent, and intuitive, and was strengthened by collaboration and iterative consultation with experts and stakeholders. CONCLUSIONS Using physician activity patterns, this novel methodology allows stakeholders to identify which physician provide anesthesia services in Canada. It is an essential step in developing a pan-Canadian anesthesia workforce strategy that can be used to examine patterns and trends related to the workforce and support evidence-informed workforce decision-making. It also establishes a foundation for assessing the effectiveness of a variety of interventions aimed at optimizing physician anesthesia services in Canada.
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Affiliation(s)
- Sarah Simkin
- Canadian Health Workforce Network and Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Beverley A. Orser
- Department of Anesthesiology & Pain Medicine, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON M5G 1E2 Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., M-wing, 3rd floor, Room M3200, Toronto, ON M4N 3M5 Canada
| | - C. Ruth Wilson
- Professor Emerita, Department of Family Medicine, Queen’s University, 220 Bagot Street, Kingston, ON K7L 3G2 Canada
| | - Ivy Lynn Bourgeault
- Canadian Health Workforce Network and School of Sociological and Anthropological Studies, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
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Morriss WW, Enright AC. The Anesthesia Workforce Crisis Revisited. Anesth Analg 2023; 136:227-229. [PMID: 36638506 DOI: 10.1213/ane.0000000000006189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Wayne W Morriss
- From the Department of Anaesthesia, University of Otago, Christchurch Hospital, Christchurch, New Zealand
| | - Angela C Enright
- University of British Columbia, Vancouver, British Columbia, Canada
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Falk R, Topstad D, Lee L. Surgical Task-Sharing in the Western Canadian Arctic: A Networked Model Between Family Physicians with Enhanced Surgical Skills and Specialist Surgeons. World J Surg 2022; 46:1629-1636. [PMID: 35325346 PMCID: PMC8943793 DOI: 10.1007/s00268-022-06524-x] [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] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
Background With the loss of generalism in the surgical specialties, there has been a move in Canada to train family physicians in enhanced surgical skills (FP-ESS) to address the surgical needs of rural and remote populations. This research project sought to describe one network integrating FP-ESS and specialist surgeons, focusing on the role of FP-ESS and their relationship with specialist surgeons, in the surgical care of the Beaufort Delta Region of the Northwest Territories of Canada. Methods Using a participatory approach, semi-structured interviews were conducted with 22 stakeholders within the surgical system. Interviews were transcribed and reviewed, then imported into NVivo 12 for analysis. First-level coding was performed based on both deductive and inductive reasoning in an iterative fashion during interview collection to develop and refine the codebook. This was followed by second-level categorizing. Results The FP-ESS physicians provide cesarean section services to maintain a local obstetrics program, to provide gastrointestinal endoscopy, and to provide emergency on-call support, as described by one stakeholder. FP-ESS work together with specialist surgeons through an informal network keeping surgical care as close to home as possible. FP-ESS within this health regions were seen as “a really big gain to the system.” Conclusions This study deepens our understanding of rural surgical service delivery, in particular where FP-ESS and specialist surgeons function collaboratively. It also contributes to strengthening rural surgical systems in Canada and therefore to addressing the health gap between rural/remote/indigenous and urban populations.
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Affiliation(s)
- Ryan Falk
- Branch for International Surgical Care, UBC Branch for International Surgical Care, Vancouver General Hospital, University of British Columbia, 2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada. .,Department of Family Medicine, UBC Branch for International Surgical Care, Vancouver General Hospital, University of British Columbia, 2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada.
| | - Dawnelle Topstad
- Department of Surgery and Family Medicine, University of Calgary, PO Box 68243, Crowfoot, Calgary, AB, T3G 3N8, Canada
| | - Laura Lee
- Branch for International Surgical Care, UBC Branch for International Surgical Care, Vancouver General Hospital, University of British Columbia, 2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada.,Research and Innovation, The Institute for International Child Rights and Development, PO Box 35039, Hillside, Victoria, BC, V8T 5G2, Canada
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Denomme J, McCarroll K, Prabhakar C, Petrar S. Videoconferencing as a tool to improve access to regional anesthesia in remote community hospitals. Can J Anaesth 2021; 68:1836-1837. [PMID: 34498232 DOI: 10.1007/s12630-021-02097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Justine Denomme
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada.
| | - Kirk McCarroll
- Department of Anesthesia, Queen Victoria Hospital, Revelstoke, BC, Canada
| | - Chris Prabhakar
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
| | - Steven Petrar
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
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Law TJ, Subhedar S, Bulamba F, O'Hara NN, Nabukenya MT, Sendagire C, Hewitt-Smith A, Lipnick MS, Tumukunde J. Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally. HUMAN RESOURCES FOR HEALTH 2021; 19:93. [PMID: 34321021 PMCID: PMC8320091 DOI: 10.1186/s12960-021-00634-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown. METHODS A survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May-June 2019. RESULTS No providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance). CONCLUSIONS No providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers.
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Affiliation(s)
- Tyler J Law
- Division of Global Health Equity, Department of Anesthesia & Perioperative Care, University of California San Francisco, 1001 Potrero Avenue, Building 5, Ward 3C, San Francisco, CA, 94110, United States of America.
| | - Shivani Subhedar
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States of America
| | - Fred Bulamba
- Department of Anesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Mary T Nabukenya
- Department of Anaesthesia, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Cornelius Sendagire
- Department of Anaesthesia, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Adam Hewitt-Smith
- Department of Anesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Michael S Lipnick
- Division of Global Health Equity, Department of Anesthesia & Perioperative Care, University of California San Francisco, 1001 Potrero Avenue, Building 5, Ward 3C, San Francisco, CA, 94110, United States of America
| | - Janat Tumukunde
- Department of Anaesthesia, Makerere University, College of Health Sciences, Kampala, Uganda
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Mossenson AI, Bailey JG, Whynot S, Livingston P. Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings. Anesth Analg 2021; 133:215-225. [PMID: 34127590 DOI: 10.1213/ane.0000000000005584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development. METHODS This qualitative study used in-depth interviews to explore VAST facilitators' perspectives on attributes and practices of effective simulation in resource-limited settings. Twenty VAST facilitators were purposively sampled and consented to be interviewed. They represented 6 low- and middle-income countries (LMICs) and 3 HICs. Interviews were conducted using a semistructured interview guide. Data analysis involved open coding to inductively identify themes using labels taken from the words of study participants and those from the relevant literature. RESULTS Emergent themes centered on 4 categories: Persona, Principles, Performance and Progression. Effective VAST facilitators embody a set of traits, style, and personal attributes (Persona) and adhere to certain Principles to optimize the simulation environment, maximize learning, and enable effective VAST Course delivery. Performance describes specific practices that well-trained facilitators demonstrate while delivering VAST courses. Finally, to advance toward competency, facilitators must seek opportunities for skill Progression.Interwoven across categories was the finding that effective VAST facilitators must be cognizant of how context, culture, and language may impact delivery of SBE. The complexity of VAST Course delivery requires that facilitators have a sensitive approach and be flexible, adaptable, and open-minded. To progress toward competency, facilitators must be open to self-reflection, be mentored, and have opportunities for practice. CONCLUSIONS The results from this study will help to develop a simulation facilitator evaluation tool that incorporates cultural sensitivity, flexibility, and a participant-focused educational model, with broad relevance across varied resource-limited environments.
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Affiliation(s)
- Adam I Mossenson
- From the Department of Anaesthesia, SJOG Midland Public and Private Hospitals, Dalhousie University, Curtin University, Perth, Western Australia
| | - Jonathan G Bailey
- Department of Anesthesia, Pain Management, and Perioperative Medicine
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Anesthesiology: Resetting Our Sights on Long-term Outcomes: The 2020 John W. Severinghaus Lecture on Translational Science. Anesthesiology 2021; 135:18-30. [PMID: 33901279 DOI: 10.1097/aln.0000000000003798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anesthesiologists have worked relentlessly to improve intraoperative anesthesia care. They are now well positioned to expand their horizons and address many of the longer-term adverse consequences of anesthesia and surgery. Perioperative neurocognitive disorders, chronic postoperative pain, and opioid misuse are not inevitable adverse outcomes; rather, they are preventable and treatable conditions that deserve attention. The author's research team has investigated why patients experience new cognitive deficits after anesthesia and surgery. Their animal studies have shown that anesthetic drugs trigger overactivity of "memory-blocking receptors" that persists after the drugs are eliminated, and they have discovered new strategies to preserve brain function by repurposing available drugs and developing novel therapeutics that inhibit these receptors. Clinical trials are in progress to examine the cognitive outcomes of such strategies. This work is just one example of how anesthesiologists are advancing science with the goal of improving the lives of patients.
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13
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James D, Evans FM, Rai E, Roy N. Delivering Essential Surgical Care for Lower-limb Musculoskeletal disorders in the Low-Resource Setting. World J Surg 2021; 45:2975-2981. [PMID: 34189619 PMCID: PMC8408055 DOI: 10.1007/s00268-021-06211-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
Background Mismatched surgeon-anesthesiologist ratios often exist in low-resource settings making safe emergency essential surgical care challenging. This study is an audit of emergency essential procedures performed for lower-limb (LL) musculoskeletal disorders (MSD) when an anesthesiologist was unavailable. It aims to identify strategies for safe anesthesia. Methods A 5-year retrospective audit of emergency essential LL orthopedic procedures performed at remote mission hospital in Central India was performed. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated. Results During this period, 766 emergency essential LL MSDs procedures were performed. An anesthesiologist was available for only 6/766. RA was administered by a surgeon for 283/766. This included spinal anesthesia (SA) for 267/283 patients, peripheral nerve blocks for 16/283. Local infiltration and/or sedation was administered to 477/766. There were 17 intraoperative surgical complications. Anesthesia-related complications included 37/267 patients who required multiple attempts to localize subarachnoid space and SA failure in 9/267 patients all of whom had successful re-administration. Additional sedation and infiltration of local anesthetic was required in 5/267 patients. Conclusion Remote pre-anesthesia consultation for high-risk patients, local surgeon-anesthesiologist networking, protocol-guided management, and dedicated short duration of training in anesthesia may be considered as an alternative for delivering RA for emergency essential surgery for LL MSDs due to unavailability of anesthesiologists.
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Affiliation(s)
- Deeptiman James
- Pediatric Orthopedic Unit, Department of Orthopedic, Christian Medical College Vellore, 1106, Paul Brand Building, Ida Scudder Road, Vellore, 632004, India.,Christian Hospital Mungeli, Mungeli, Chhattisgarh, 495334, India
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, US
| | - Ekta Rai
- Department of Anesthesia, Head of Pediatric and ObGyn Anesthesia unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nobhojit Roy
- WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, BARC Hospital, HBNI University, Mumbai, India. .,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Orser BA, Wilson CR. Canada needs a national strategy for anesthesia services in rural and remote regions. CMAJ 2021; 192:E861-E863. [PMID: 32719023 DOI: 10.1503/cmaj.200215] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Beverley A Orser
- Department of Anesthesiology and Pain Medicine (Orser), University of Toronto; Department of Anesthesia (Orser), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Family Medicine (Wilson), Queen's University, Kingston, Ont
| | - C Ruth Wilson
- Department of Anesthesiology and Pain Medicine (Orser), University of Toronto; Department of Anesthesia (Orser), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Family Medicine (Wilson), Queen's University, Kingston, Ont.
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15
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Carlough M, Chetwynd E, Muthler S, Page C. Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure. South Med J 2021; 114:92-97. [PMID: 33537790 DOI: 10.14423/smj.0000000000001208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Almost 15% of all US births occur in rural hospitals, yet rural hospitals are closing at an alarming rate because of shortages of delivering clinicians, nurses, and anesthesia support. We describe maternity staffing patterns in successful rural hospitals across North Carolina. METHODS All of the hospitals in the state with ≤200 beds and active maternity units were surveyed. Hospitals were categorized into three sizes: critical access hospitals (CAHs) had ≤25 acute staffed hospital beds, small rural hospitals had ≤100 beds without being defined as CAHs, and intermediate rural hospitals had 101 to 200 beds. Qualitative data were collected at a selection of study hospitals during site visits. Eighteen hospitals were surveyed. Site visits were completed at 8 of the surveyed hospitals. RESULTS Nurses in CAHs were more likely to float to other units when Labor and Delivery did not have patients and nursing management was more likely to assist on Labor and Delivery when patient census was high. Anesthesia staffing patterns varied but certified nurse anesthetists were highly used. CAHs were almost twice as likely to accept patients choosing a trial of labor after cesarean section (CS) than larger hospitals, but CS rates were similar across all hospital types. Hospitals with only obstetricians as delivering providers had the highest CS rate (32%). The types of hospitals with the lowest CS rates were the hospitals with only family physicians (24%) or high proportions of certified nurse midwives (22%). CONCLUSIONS Innovative staffing models, including family physicians, nurse midwives, and nurse anesthetists, are critical for the survival of rural hospitals that provide vital maternity services in underserved areas.
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Affiliation(s)
- Martha Carlough
- From the School of Medicine, the Department of Family Medicine, and the Department of Maternal and Child Health, Gilling School of Global Public Health, University of North Carolina, Chapel Hill
| | - Ellen Chetwynd
- From the School of Medicine, the Department of Family Medicine, and the Department of Maternal and Child Health, Gilling School of Global Public Health, University of North Carolina, Chapel Hill
| | - Sarah Muthler
- From the School of Medicine, the Department of Family Medicine, and the Department of Maternal and Child Health, Gilling School of Global Public Health, University of North Carolina, Chapel Hill
| | - Cristen Page
- From the School of Medicine, the Department of Family Medicine, and the Department of Maternal and Child Health, Gilling School of Global Public Health, University of North Carolina, Chapel Hill
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Premkumar K, Umaefulam V, O’Brien JM. Mobile medical simulation for rural anesthesia providers: A feasibility study. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e60-e71. [PMID: 33349755 PMCID: PMC7749662 DOI: 10.36834/cmej.69572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Family practice anesthesia (FPA) providers are family physicians trained to deliver anesthesia care; they often practice in rural hospitals to facilitate surgical care. FPA providers in rural hospitals face challenges including professional isolation and limited opportunities for formal continuing education. To address needs identified by FPA providers, we piloted mobile medical simulation in rural Saskatchewan. METHODS Using a logic model framework, we evaluated feasibility of a one-day interdisciplinary mobile simulation workshop for healthcare providers in a rural Saskatchewan hospital. As part of this mixed methods pilot study, we interviewed stakeholders to explore their perceptions of human and financial resources associated with delivering medical simulations in rural locations. Multiple simulation scenarios were utilized to train participants in clinical and professional skills. Participants completed pre- and post-workshop surveys to evaluate their experience. RESULTS Financial and human resources included cost of renting, transportation of mannequins, and the time required to create the scenarios. Participants (n = 10) reported improved knowledge and found the experience valuable. The session prompted participants to reflect on their deficiencies in certain clinical procedures/skills and highlight learning strategies to address the gap. DISCUSSION Mobile medical simulation brought continuing medical education (CME) to health professionals in a rural location, but the program was expensive. Our logic model may inform educators and administrators considering mobile medical simulation for physicians in rural areas when balancing resource allocation and the organization's commitment to CME for rural physicians.
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Affiliation(s)
- Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Jennifer M. O’Brien
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
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Jaworsky D, Loutfy M, Lu M, Ye M, Bratu A, Sereda P, Bayoumi A, Richardson L, Kuper A, Hogg RS. Influence of the definition of rurality on geographic differences in HIV outcomes in British Columbia: a retrospective cohort analysis. CMAJ Open 2020; 8:E643-E650. [PMID: 33077535 PMCID: PMC7588262 DOI: 10.9778/cmajo.20200066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Improving rural health is often identified as a priority area for research and policy in Canada. We examined how findings on HIV outcomes (virologic suppression) can vary depending on the definition of rurality used. METHODS We performed retrospective cohort analyses using the Comparative Outcomes and Service Utilization Trends study population-based cohort of adults (age ≥ 19 yr) living with HIV in British Columbia between Apr. 1, 2012, and Mar. 31, 2013. We performed univariate logistic regression analyses using the following geographic variables to predict HIV virologic suppression: rurality defined by forward sortation area, by Statistical Area Classification and by health authority. We mapped suppression using geographic information systems. RESULTS Virologic suppression was observed in 5605 (65.2%) of 8598 participants. In univariate analysis, rurality defined by Statistical Area Classification (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.65-0.82), but not by forward sortation area, was associated with lower odds of suppression. When we examined suppression by health authority, Northern Health had the lowest odds of suppression (OR 0.46, 95% CI 0.36-0.58 compared to Vancouver Coastal Health). Geographic information systems mapping showed poorer suppression in northern areas. INTERPRETATION Health outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.
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Affiliation(s)
- Denise Jaworsky
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Mona Loutfy
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Michelle Lu
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Monica Ye
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Andreea Bratu
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Paul Sereda
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Ahmed Bayoumi
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Lisa Richardson
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Ayelet Kuper
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Robert S Hogg
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
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Why every anesthesia trainee should receive global health equity education. Can J Anaesth 2020; 67:924-935. [DOI: 10.1007/s12630-020-01715-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/31/2022] Open
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Buhiire J, Mildenberger A, Epp R, Bajwa J, Dease M, O'Brien J. Factors influencing Canadian family practice anesthetists' retention: a cross-sectional survey. Can J Anaesth 2020; 67:760-765. [PMID: 32291622 DOI: 10.1007/s12630-020-01636-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/17/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joel Buhiire
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of SK, Saskatoon, Canada
| | - Adam Mildenberger
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of SK, Saskatoon, Canada
| | - Rebecca Epp
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of SK, Saskatoon, Canada
| | - Jagmeet Bajwa
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of SK, Saskatoon, Canada
| | - Murray Dease
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of SK, Saskatoon, Canada
| | - Jennifer O'Brien
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of SK, Saskatoon, Canada.
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20
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Enright A, Mitchell R. "Go to the People. Live Among Them." Reflections on Anesthetic and Surgical Care in Rural and Remote Regions. Anesth Analg 2020; 129:13-15. [PMID: 31206447 DOI: 10.1213/ane.0000000000004210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Angela Enright
- From the Department of Anesthesia, University of British Columbia, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Rodney Mitchell
- Department of Anesthesia, University of Adelaide, Adelaide, South Australia, Australia
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Musings from an Unlikely Clinician-Scientist: 2018 American Society of Anesthesiologists Excellence in Research Award. Anesthesiology 2019; 131:795-800. [PMID: 31335546 DOI: 10.1097/aln.0000000000002881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article, which stems from the 2018 American Society of Anesthesiologists Excellence in Research Award Lecture, aims to encourage young investigators, offer advice, and share several early life experiences that have influenced the author's career as an anesthesiologist and clinician-scientist. The article also describes key discoveries that have increased understanding of the role of γ-aminobutyric acid type A (GABAA) receptors in health and disease. The author's research team identified the unique pharmacologic properties of extrasynaptic GABAA receptors and their role in the anesthetic state. The author's team also showed that extrasynaptic GABAA receptors expressed in neuronal and nonneuronal cells contribute to a variety of disorders and are novel drug targets. The author's overarching message is that young investigators must create their own unique narratives, train hard, be relentless in their studies and-most important-enjoy the journey of discovering new truths that will ultimately benefit patients.
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