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Chen F, Belgique ST, Canter C, Boscardin CK, Willie C, Mitchell JD, Sullivan K, Martinelli SM. Unprofessionalism in anesthesiology: A qualitative study on classifying unprofessional behavior in anesthesiology residency education. J Clin Anesth 2024; 95:111429. [PMID: 38460412 DOI: 10.1016/j.jclinane.2024.111429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
STUDY OBJECTIVE This study aims to identify the domains that constitute behaviors perceived to be unprofessional in anesthesiology residency training programs. DESIGN Qualitative study. SETTING Anesthesiology residency training programs. PATIENTS Not applicable. The participants involved residents, fellows, and faculty members purposefully sampled in four US-based anesthesiology residency programs. INTERVENTIONS Participants were asked to submit examples of unprofessional behavior they witnessed in anesthesiology residents, fellows, or faculty members via a Qualtrics link. MEASUREMENTS Not applicable. The behavior examples were independently reviewed and categorized into themes using content analysis. MAIN RESULTS A total of 116 vignettes were collected, resulting in a final list of 111 vignettes after excluding those that did not describe behavior exhibited by anesthesiology faculty or trainees. Fifty-eight vignettes pertained to unprofessional behaviors observed in faculty members and 53 were observed in trainees (residents and fellows). Nine unprofessionalism themes emerged in the analysis. The most common themes were VERBAL, SUPERVISION, QUALITY, ENGAGEMENT, and TIME. As to the distribution of role group (faculty versus trainee) by theme, unprofessional behaviors falling into the categories of BIAS, GOSSIP, LEWD, and VERBAL were observed more in faculty; whereas themes with unprofessional behavior primarily attributed to trainees included ENGAGEMENT, QUALITY, TIME, and SUPERVISION. CONCLUSION By reviewing reported professionalism-related vignettes within residency training programs, we identified classification descriptors for defining unprofessional behavior specific to anesthesiology residency education. Findings from this study enrich the definition of professionalism as a multi-dimensional competency pertaining to anesthesiology graduate medical education. This framework may facilitate preventative intervention and timely remediation plans for unprofessional behavior in residents and faculty.
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Affiliation(s)
- Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States.
| | | | - Courtney Canter
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States
| | - Christy K Boscardin
- Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, 94143, United States
| | - Chelsea Willie
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - John D Mitchell
- Department of Anesthesiology, Pain Management, and Perioperative Care, Henry Ford Health, Detroit, MI, 48105, United States; Department of Anesthesiology, Michigan State University College of Human Medicine, Grand Rapids, MI, 49503, United States
| | - Kristina Sullivan
- Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, 94143, United States
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States
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Chen F, Martinelli SM. In response to "Counting episodes of poor-quality faculty anesthesiologists' supervision and anesthesia residents' work habits among reported vignettes of insufficient professionalism". J Clin Anesth 2024; 95:111456. [PMID: 38569332 DOI: 10.1016/j.jclinane.2024.111456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
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Martinelli SM, Tran TN, Chidgey BA, Isaak RS, Teeter EG, Chen F. Family Anesthesia Experience: Improving Social Support of Residents Through Education of Their Family and Friends. MedEdPORTAL 2023; 19:11370. [PMID: 38106624 PMCID: PMC10721742 DOI: 10.15766/mep_2374-8265.11370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/26/2023] [Indexed: 12/19/2023]
Abstract
Introduction The prevalence of burnout among anesthesiology residents is 41%-51%. Burnout is associated with medical errors, physician turnover, and substance use disorder. Social support and wellness may reduce burnout, but a barrier is support persons' lack of understanding of an anesthesiologist's work demands. We developed the Family Anesthesia Experience (FAX) to help support persons best support their resident. Methods FAX consisted of a 4-hour event with hands-on experience, didactics portion, and panel discussion. Participants learned about a typical day in the life of an anesthesiology resident, wellness, burnout, substance use disorder, and available support resources, and had hands-on experience with procedures. The panel discussion offered logistical information about anesthesiology residency and allowed support persons to ask panel members questions. A postevent survey collected feedback on the event. Results Fifty-one participants (first-year anesthesiology residents and their support persons) attended the event. Eight of 11 residents (73%) and 32 of 40 support persons (80%) completed the survey. All enjoyed the event, would recommend it to other anesthesiology resident support persons, and felt the event would improve communication and support. Most learned a moderate (35%) to large amount (50%) from the event. Qualitative feedback suggested most support persons found the event helpful in improving their understanding of anesthesiology residents' work demands. Discussion The FAX was well liked by participants. Although we did not assess specific knowledge gained and long-term effects of the 2022 event, evaluations of previous years' events suggest that the event improved participants' understanding of anesthesiology residents' work and stressors.
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Affiliation(s)
- Susan M. Martinelli
- Professor, Department of Anesthesiology, Director, Anesthesiology Residency Program, and Co-Director, TEACHER Lab, University of North Carolina at Chapel Hill School of Medicine
| | - Thanh N. Tran
- Research Assistant, TEACHER Lab, University of North Carolina at Chapel Hill School of Medicine
| | - Brooke A. Chidgey
- Associate Professor, Department of Anesthesiology, and Division Chief, Pain Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Robert S. Isaak
- Professor, Department of Anesthesiology, Vice Chair, Education, and Division Chief, Liver Transplant and Vascular Anesthesia, University of North Carolina at Chapel Hill School of Medicine
| | - Emily G. Teeter
- Professor, Department of Anesthesiology, and Associate Director, Anesthesiology Residency Program, University of North Carolina at Chapel Hill School of Medicine
| | - Fei Chen
- Assistant Professor, Department of Anesthesiology, and Co-Director, TEACHER Lab, University of North Carolina at Chapel Hill School of Medicine
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Martinelli SM, Isaak R, Canter C, Meltzer-Brody S, Nichols K, Grewe M, Chen F. The Family Experience: A Family-Focused Support Intervention to Enhance Wellness in Undergraduate Medical Education. Acad Med 2023; 98:S180-S181. [PMID: 37983425 DOI: 10.1097/acm.0000000000005397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Susan M Martinelli
- Author affiliations: S.M. Martinelli, R. Isaak, C. Canter, S. Meltzer-Brody, K. Nichols, M. Grewe, F. Chen, University of North Carolina School of Medicine
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Chen F, Stiegler M, Martinelli SM, Arora H, Isaak RS. No Miracles in Two Minutes: A Randomized Controlled Study on the Impact of Preparatory Expansive Posing on Anesthesiology Residents' Performance in Mock Structured Oral Examinations. J Educ Perioper Med 2023; 25:E700. [PMID: 37377508 PMCID: PMC10291955 DOI: 10.46374/volxxv_issue2_chen] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Background The objective of this study was to evaluate the impact of engaging in preparatory expansive posing on the performance of anesthesiology trainees during a mock structured oral examination. Methods A total of 38 clinical residents at a single institution participated in this prospective randomized controlled study. Participants were stratified by clinical anesthesia year and randomly assigned to 1 of 2 orientation rooms to prepare for the examination. The preparatory expansive posing participants stood for 2 minutes with their hands and arms above their heads and with their feet approximately 1 ft apart. Conversely, the control participants sat quietly in a chair for 2 minutes. All participants then received the same orientation and examination. Faculty evaluation of resident performance, residents' self-assessment of performance, and anxiety score were collected. Results There was no evidence to support our primary hypothesis that residents who engaged in preparatory expansive posing for 2 minutes prior to a mock structured oral examination would score higher than their control counterparts (P = .68). There was no evidence to support our secondary hypotheses that preparatory expansive posing increases self-assessment of one's performance (P = .31) or reduces perceived anxiety during a mock structured oral examination (P = .85). Conclusions Preparatory expansive posing did not improve anesthesiology residents' mock structured oral examination performance or self-assessment of their performance, nor did it reduce their perceived anxiety. Preparatory expansive posing is likely not a useful technique in improving the performance of residents in structured oral examinations.
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Affiliation(s)
- Fei Chen
- The authors are in the Department of Anesthesiology, University of North Carolina at Chapel Hill in Chapel Hill, NC. Fei Chen is an Assistant Professor; Marjorie Stiegler is an Adjunct Associate Professor; Susan M. Martinelli, Harendra Arora, and Robert S. Isaak are Professors
| | - Marjorie Stiegler
- The authors are in the Department of Anesthesiology, University of North Carolina at Chapel Hill in Chapel Hill, NC. Fei Chen is an Assistant Professor; Marjorie Stiegler is an Adjunct Associate Professor; Susan M. Martinelli, Harendra Arora, and Robert S. Isaak are Professors
| | - Susan M. Martinelli
- The authors are in the Department of Anesthesiology, University of North Carolina at Chapel Hill in Chapel Hill, NC. Fei Chen is an Assistant Professor; Marjorie Stiegler is an Adjunct Associate Professor; Susan M. Martinelli, Harendra Arora, and Robert S. Isaak are Professors
| | - Harendra Arora
- The authors are in the Department of Anesthesiology, University of North Carolina at Chapel Hill in Chapel Hill, NC. Fei Chen is an Assistant Professor; Marjorie Stiegler is an Adjunct Associate Professor; Susan M. Martinelli, Harendra Arora, and Robert S. Isaak are Professors
| | - Robert S. Isaak
- The authors are in the Department of Anesthesiology, University of North Carolina at Chapel Hill in Chapel Hill, NC. Fei Chen is an Assistant Professor; Marjorie Stiegler is an Adjunct Associate Professor; Susan M. Martinelli, Harendra Arora, and Robert S. Isaak are Professors
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Chen F, Isaak R, Afroze F, Mulaikal TA, Licatino LK, Ladlie B, Jain A, Willie C, Bairde E, Hayes BH, Carter T, Zisblatt L, Diachun C, Martin TW, Marshall JM, Huffmyer J, Hindle AK, Stahl DL, Liu Y, Martinelli SM. A Multi-Site Survey Study on the Association Between the COVID-19 Pandemic and United States Anesthesiology Residents' Mental Health. Cureus 2023; 15:e34782. [PMID: 36915835 PMCID: PMC10005895 DOI: 10.7759/cureus.34782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND At the onset of the coronavirus disease 2019 (COVID-19) pandemic, anesthesiology residency programs were impacted differently due to various factors such as the local severity of COVID-19, exposure to patient suffering, and inability to complete rotations. We sought to investigate the impact of local-level pandemic severity on the well-being of anesthesiology residents. METHODS This multi-site study surveyed postgraduate year two residents from 15 United States (US) anesthesiology programs using the Perceived Stress Scale, Mini-Z, Patient Health Questionnaire-9,WHO-5 Well-Being Index,and the Multidimensional Scale of Perceived Social Support before the pandemic (baseline survey) and during the first COVID-19 surge (post survey). RESULTS A total of 144 (65%) residents responded to the initial baseline survey; 73 (33%) responded to the post survey, and 49 (22%) completed both surveys. There was not a statistically significant difference in any well-being outcomes of participants between the surveys, nor was there a significant difference based on the severity of COVID-19 impact at the program's hospital. Male participants had higher perceived stress scores (β = 4.05, 95%CI: 0.42, 7.67, P = 0.03) and lower social support from family (β = -6.57, 95%CI: -11.64, -1.51, P = 0.01) at the post survey compared to female participants after controlling for baseline scores. Additionally, married participants or those with domestic partners reported higher perceived social support in the post survey (β = 5.79, 95%CI: -0.65, 12.23, P = 0.03). CONCLUSION The local COVID-19 severity at a residency program did not disproportionately impact well-being scores among anesthesiology residents. Those most vulnerable to diminished well-being appeared to be male and single participants. As a result, targeted well-being interventions, including those aiming to increase social support, to higher-risk resident groups may be indicated. Future work is needed to assess the longstanding COVID-19 pandemic impacts on resident well-being.
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Affiliation(s)
- Fei Chen
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Robert Isaak
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Farzana Afroze
- Department of Anesthesiology, Albany Medical Center, Albany, USA
| | - Teresa A Mulaikal
- Department of Anesthesiology, Columbia University, New York City, USA
| | - Lauren K Licatino
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, USA
| | - Beth Ladlie
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
| | - Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, USA
| | - Chelsea Willie
- Department of Anesthesiology and Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Emily Bairde
- Department of Anesthesiology, Oregon Health & Science University, Portland, USA
| | - Blair H Hayes
- Department of Anesthesiology, The Ohio State University, Columbus, USA
| | - Tekuila Carter
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Lara Zisblatt
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - Carol Diachun
- Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, USA
| | - Timothy W Martin
- Department of Anesthesiology, University of Florida, Gainesville, USA
| | - Julie M Marshall
- Department of Anesthesiology, University of Missouri, Columbia, USA
| | - Julie Huffmyer
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Anna K Hindle
- Department of Anesthesiology, The George Washington University, Washington, D.C., USA
| | - David L Stahl
- Department of Anesthesiology, The Ohio State University, Columbus, USA
| | - Yutong Liu
- Department of Biostatistics, University of North Carolina, Chapel Hill, USA
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel HIll, USA
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Brown KB, Cook A, Chen F, Martinelli SM. A Perspective on Wellness in Anesthesiology Residency Programs: A Multi-Strategy Approach. Anesthesiol Clin 2022; 40:257-274. [PMID: 35659399 DOI: 10.1016/j.anclin.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Addressing resident wellness is an important topic given the high risk for burnout and depression in resident physicians compared with the general U.S. population. This article provides an overview of various approaches to help conceptualize and intervene on resident wellness, based on the 9-strategies framework to improve wellness laid out by Shanafelt and colleagues. This article outlines the most relevant literature in each strategy followed by the authors' experience within their anesthesiology residency program.
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Affiliation(s)
- Kenneth B Brown
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| | - Arianna Cook
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
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Chen MJ, Ambardekar A, Martinelli SM, Buhl LK, Walsh DP, Levy L, Ku C, Rubenstein LA, Neves S, Mitchell JD. Defining and Addressing Anesthesiology Needs in Simulation-based Medical Education. J Educ Perioper Med 2022; 24:1-15. [PMID: 36051401 PMCID: PMC9426263 DOI: 10.46374/volxxiv_issue2_mitchell] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND This study's primary aim was to determine how training programs use simulation-based medical education (SBME), because SBME is linked to superior clinical performance. METHODS An anonymous 10-question survey was distributed to anesthesiology residency program directors across the United States. The survey aimed to assess where and how SBME takes place, which resources are available, frequency of and barriers to its use, and perceived utility of a dedicated departmental education laboratory. RESULTS The survey response rate was 30.4% (45/148). SBME typically occurred at shared on-campus laboratories, with residents typically participating in SBME 1 to 4 times per year. Frequently practiced skills included airway management, trauma scenarios, nontechnical skills, and ultrasound techniques (all ≥ 77.8%). Frequently cited logistical barriers to simulation laboratory use included COVID-19 precautions (75.6%), scheduling (57.8%), and lack of trainers (48.9%). Several respondents also acknowledged financial barriers. Most respondents believed a dedicated departmental education laboratory would be a useful or very useful resource (77.8%). CONCLUSION SBME is a widely incorporated activity but may be impeded by barriers that our survey helped identify. Barriers can be addressed by departmental education laboratories. We discuss how such laboratories increase capabilities to support structured SBME events and how costs can be offset. Other academic departments may also benefit from establishing such laboratories.
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Affiliation(s)
- Michael J. Chen
- The following authors are in the Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA: Michael J. Chen is a Research Assistant at Beth Israel; Lauren K. Buhl, Daniel P. Walsh, and Lindsay A. Rubenstein are Associate Residency Program Directors at Beth Israel and also Instructors in Anaesthesia at Harvard Medical School, Cambridge, MA; Lior Levy is Director of Resident Simulation in the Anesthesia Department at Beth Israel and also Instructor in Anaesthesia at Harvard Medical School
| | - Aditee Ambardekar
- Aditee Ambardekar is a Residency Program Director and Associate Professor at Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Susan M. Martinelli
- Susan M. Martinelli is a Residency Program Director and Professor of Anesthesia, Department of Anesthesiology, The University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Lauren K. Buhl
- The following authors are in the Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA: Michael J. Chen is a Research Assistant at Beth Israel; Lauren K. Buhl, Daniel P. Walsh, and Lindsay A. Rubenstein are Associate Residency Program Directors at Beth Israel and also Instructors in Anaesthesia at Harvard Medical School, Cambridge, MA; Lior Levy is Director of Resident Simulation in the Anesthesia Department at Beth Israel and also Instructor in Anaesthesia at Harvard Medical School
| | - Daniel P. Walsh
- The following authors are in the Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA: Michael J. Chen is a Research Assistant at Beth Israel; Lauren K. Buhl, Daniel P. Walsh, and Lindsay A. Rubenstein are Associate Residency Program Directors at Beth Israel and also Instructors in Anaesthesia at Harvard Medical School, Cambridge, MA; Lior Levy is Director of Resident Simulation in the Anesthesia Department at Beth Israel and also Instructor in Anaesthesia at Harvard Medical School
| | - Lior Levy
- The following authors are in the Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA: Michael J. Chen is a Research Assistant at Beth Israel; Lauren K. Buhl, Daniel P. Walsh, and Lindsay A. Rubenstein are Associate Residency Program Directors at Beth Israel and also Instructors in Anaesthesia at Harvard Medical School, Cambridge, MA; Lior Levy is Director of Resident Simulation in the Anesthesia Department at Beth Israel and also Instructor in Anaesthesia at Harvard Medical School
| | - Cindy Ku
- Cindy Ku is an Anesthesiologist, Department of Anesthesiology, Queen’s Medical Center, Honolulu Clinical Assistant Professor, Department of Surgery, John A Burns School of Medicine, University of Hawaii
| | - Lindsay A. Rubenstein
- The following authors are in the Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA: Michael J. Chen is a Research Assistant at Beth Israel; Lauren K. Buhl, Daniel P. Walsh, and Lindsay A. Rubenstein are Associate Residency Program Directors at Beth Israel and also Instructors in Anaesthesia at Harvard Medical School, Cambridge, MA; Lior Levy is Director of Resident Simulation in the Anesthesia Department at Beth Israel and also Instructor in Anaesthesia at Harvard Medical School
| | - Sara Neves
- Sara Neves is a Residency Program Director at Beth Israel and also Instructor in Anaesthesia at Harvard Medical School
| | - John D. Mitchell
- John D. Mitchell is the Vice Chair for Academic Affairs in the Department of Anesthesiology, Pain Management, and Perioperative Medicine at Henry Ford Health
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Zwemer E, Chen F, Beck Dallaghan GL, Shenvi C, Wilson L, Resnick-Kahle M, Crowner J, Joyner BL, Westervelt L, Jordan JM, Chuang A, Shaheen A, Martinelli SM. Reinvigorating an Academy of Medical Educators Using Ecological Systems Theory. Cureus 2022; 14:e21640. [PMID: 35233317 PMCID: PMC8881048 DOI: 10.7759/cureus.21640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Abstract
The educational framework of communities of practice postulates that early learners join medical communities as social networks that provide a common identity, role modeling and mentorship, and experiential learning. While being elected into a medical society is an honor, member engagement in these groups can falter if the society membership is seen as an honorific rather than one requiring continuing participation. As an example, Academies of Medical Educators have been established by many academic medical centers to encourage collaboration, skill development, professional identity formation, and scholarship. The University of North Carolina established the Academy of Educators in 2006 to create a diverse community of educators to promote the scholarship, teaching skills, and professional identity of educators. Despite rapid growth to over 500 members, we had less than 30 participants at events over the 2017-2018 academic year. To increase member engagement and participation, our academy leadership team used Bronfenbrenner’s Ecological Systems Theory to design interventions at each layer of environmental influence, specifically at the microsystem, mesosystem, exosystem, macrosystem, and chronosystem levels. In this paper, we describe the multipronged approach used to increase the University of North Carolina Academy of Medical Educators event attendance from 30 to 1,000 faculty participants over the course of one academic year (2018-2019). This paper provides a model as to how medical societies can use ecological systems theory as a natural and comprehensive approach to plan and improve their member engagement and experience.
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Martinelli SM, Chen F, Isaak RS, Hendrickse A, Mahoney B, Diachun CAB, Mitchell JD. Transitioning to Virtual Meetings: Experiences From the Society for Education in Anesthesia Virtual Fall 2020 Meeting. J Educ Perioper Med 2021; 23:E667. [PMID: 34631965 PMCID: PMC8491636 DOI: 10.46374/volxxiii_issue3_martinelli] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has forced organizers of traditional in-person continuing medical education conferences to transition to a virtual format. There are both advantages and disadvantages to this change in format. When planning a virtual meeting, several factors require consideration, including costs, virtual platforms, sponsorship, networking, and meeting logistics. This manuscript describes the authors' experiences of transforming the Society of Education in Anesthesia 2020 Fall Meeting into a virtual conference and explores the lessons learned and future impacts of this new medium.
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Martinelli SM, Chen F, Isaak RS, Huffmyer JL, Neves SE, Mitchell JD. Educating Anesthesiologists During the Coronavirus Disease 2019 Pandemic and Beyond. Anesth Analg 2021; 132:585-593. [PMID: 33201006 DOI: 10.1213/ane.0000000000005333] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has altered approaches to anesthesiology education by shifting educational paradigms. This vision article discusses pre-COVID-19 educational methodologies and best evidence, adaptations required under COVID-19, and evidence for these modifications, and suggests future directions for anesthesiology education. Learning management systems provide structure to online learning. They have been increasingly utilized to improve access to didactic materials asynchronously. Despite some historic reservations, the pandemic has necessitated a rapid uptake across programs. Commercially available systems offer a wide range of peer-reviewed curricular options. The flipped classroom promotes learning foundational knowledge before teaching sessions with a focus on application during structured didactics. There is growing evidence that this approach is preferred by learners and may increase knowledge gain. The flipped classroom works well with learning management systems to disseminate focused preclass work. Care must be taken to keep virtual sessions interactive. Simulation, already used in anesthesiology, has been critical in preparation for the care of COVID-19 patients. Multidisciplinary, in situ simulations allow for rapid dissemination of new team workflows. Physical distancing and reduced availability of providers have required more sessions. Early pandemic decreases in operating volumes have allowed for this; future planning will have to incorporate smaller groups, sanitizing of equipment, and attention to use of personal protective equipment. Effective technical skills training requires instruction to mastery levels, use of deliberate practice, and high-quality feedback. Reduced sizes of skill-training workshops and approaches for feedback that are not in-person will be required. Mock oral and objective structured clinical examination (OSCE) allow for training and assessment of competencies often not addressed otherwise. They provide formative and summative data and objective measurements of Accreditation Council for Graduate Medical Education (ACGME) milestones. They also allow for preparation for the American Board of Anesthesiology (ABA) APPLIED examination. Adaptations to teleconferencing or videoconferencing can allow for continued use. Benefits of teaching in this new era include enhanced availability of asynchronous learning and opportunities to apply universal, expert-driven curricula. Burdens include decreased social interactions and potential need for an increased amount of smaller, live sessions. Acquiring learning management systems and holding more frequent simulation and skills sessions with fewer learners may increase cost. With the increasing dependency on multimedia and technology support for teaching and learning, one important focus of educational research is on the development and evaluation of strategies that reduce extraneous processing and manage essential and generative processing in virtual learning environments. Collaboration to identify and implement best practices has the potential to improve education for all learners.
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Affiliation(s)
- Susan M Martinelli
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Fei Chen
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Robert S Isaak
- From the Department of Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Sara E Neves
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - John D Mitchell
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Koski-Vacirca R, Zaidi D, Macko L, Prasad T, Karamchandani RR, Singh S, Asimos AW, Chen F, Isaak RS, Steiner BD, Martinelli SM, Weissler EH, Kibbe MR, Mann JWF, Caulfield H, Harr C, Hildreth AN, Krahnert JF, Reinke CE, Snyder JR, Tuttle-Newhall JE, Wyatt J, Shortell CK. Letters of Correspondence: COVID-19 and Student Advocacy, Medical Education, Surge Response, and Testing. N C Med J 2021; 82:83-86. [PMID: 33397766 DOI: 10.18043/ncm.82.1.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ryan Koski-Vacirca
- MD candidate, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Danish Zaidi
- Resident physician, Yale-New Haven Hospital and Yale School of Medicine, New Haven, Connecticut
| | - Lauren Macko
- Clinical nurse specialist, Neurosciences Institute, Atrium Health, Charlotte, North Carolina.
| | | | - Rahul R Karamchandani
- Neurologist, Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, North Carolina
| | - Sam Singh
- Senior clinical analyst, Atrium Health, Charlotte, North Carolina
| | - Andrew W Asimos
- Medical director, Carolinas Stroke Network, Neurosciences Institute, Atrium Health, Charlotte, North Carolina
| | - Fei Chen
- Assistant professor, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert S Isaak
- Associate professor of anesthesiology and assistant residency program director, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Beat D Steiner
- Professor and senior associate dean for medical student education, Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan M Martinelli
- Professor of anesthesiology and residency program director, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - E Hope Weissler
- Resident, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Melina R Kibbe
- Chair, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - John W F Mann
- President and COO, Novant Health Clemmons Medical Center, Novant Health Medical System, Winston-Salem, North Carolina
| | - Harry Caulfield
- Surgery service line physician administrator, CaroMont Regional Medical Center, Gastonia, North Carolina
| | - Charles Harr
- Chief medical officer, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Amy N Hildreth
- General surgery residency program director, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John F Krahnert
- Chief medical officer, FirstHealth of the Carolinas, Pinehurst, North Carolina
| | | | - Jonathan R Snyder
- Chief medical officer, Hugh Chatham Memorial Hospital, Elkin, North Carolina
| | - Janet E Tuttle-Newhall
- Chair, Department of Surgical Immunology and Transplantation, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Jay Wyatt
- Chief medical officer, The Moses H. Cone Memorial Hospital, Cone Health, Greensboro, North Carolina
| | - Cynthia K Shortell
- Executive vice chair, Department of Surgery and chief, Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, North Carolina.
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Martinelli SM, Isaak RS, Chidgey BA, Bullard TL, DiLorenzo A, Rebel A, Chen F. Family Comes First: A Pilot Study of the Incorporation of Social Support Into Resident Well-being. J Educ Perioper Med 2020; 22:E652. [PMID: 33447651 PMCID: PMC7792563 DOI: 10.46374/volxxii-issue4-martinelli] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent work has shown that understanding of work-related stress by family and friends is associated with increased resident well-being. However, it is often difficult for residents to communicate with their support persons (SPs), especially those who have minimal understanding of the medical field, regarding even the most basic functions of their role in the health care system. This study aimed to pilot test an innovative wellness event focusing on the social relatedness component of resident well-being. METHODS The target population included 30 new residents at 2 anesthesiology residency programs and their SPs in 2017. The Family Anesthesia Experience (FAX) began with didactic presentations and a panel discussion about wellness topics. It concluded with a multifaceted simulation experience. Participants were surveyed before and after the event. Measures included SPs' understanding of residents' work and residents' stress, burnout, resilience, and social support levels. Student t tests, Mann-Whitney U tests, Wilcoxon signed-rank tests, and repeated measures analysis of variance were used to examine the impact of the event. RESULTS Twenty-two (84.6%) of the 26 intervention clinical anesthesia year 1 residents who attended FAX completed the postevent surveys, and all intervention SPs (100%, n = 33) completed both pre-event and postevent surveys. The event was well received by the residents (100%) and their SPs (100%). Improvement in perceived understanding in the intervention SPs group (Pre: 1.44 ± 0.63, Post: 2.69 ± 0.33, P < .0001) was observed. Not all metrics of well-being for the residents achieved significance in change; however, decreased stress was observed compared with historical controls (Control: 1.91 ± 0.61, Intervention: 1.54 ± 0.42, P = .019). CONCLUSION The event led to improved SPs' understanding of the role of an anesthesiology resident.
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Chen F, Carter TB, Maguire DP, Blanchard EE, Martinelli SM, Isaak RS. Experience Is the Teacher of All Things: Prior Participation in Anesthesiology OSCEs Enhances Communication of Treatment Options With Simulated High-Risk Patients. J Educ Perioper Med 2019; 21:E626. [PMID: 31988987 PMCID: PMC6973018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The objective of this study was to investigate whether previous experiences within an anesthesiology-based Objective Structured Clinical Examination (OSCE) assessing communication and professionalism skills was associated with improved performance in a subsequent anesthesiology-based OSCE scenario. METHODS This retrospective multi-center study used the performance data of 44 Post Graduate Year 4 clinical anesthesia residents from 3 US anesthesiology residency programs on an OSCE scenario that assessed the residents' effectiveness of discussing anesthesiology-specific treatment options with a high-risk patient. Residents from 2 of the programs had no prior anesthesiology-based OSCE experience. Residents from the third program had previously participated in 4 separate multi-scenario anesthesiology-based OSCE sessions in the 2 years prior to this study. Participating residents completed the same scenario at their respective institutions' simulation center. Ten performances were randomly selected for double rating to assess the interrater reliability of the assessments. Interrater reliability was good for the scenario (intraclass correlation coefficient = 0.66, 95% confidence interval = 0.12-0.90). Performance difference between groups with different OSCE experience status were examined using an independent sample t test, with a Wilcoxon-Mann-Whitney test as a sensitivity analysis. RESULTS Independent sample t test found prior OSCE experience was significantly associated with higher performance scores (t = 2.53, P = .02). The Wilcoxon-Mann-Whitney test result confirmed this finding (z = 3.28, P = .001). CONCLUSIONS Findings from this study provide preliminary evidence that anesthesiology-based OSCE experience is associated with improved performance in an OSCE scenario, specifically regarding discussions of treatment options with high-risk patients.
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Chen F, Arora H, Zvara DA, Connolly A, Martinelli SM. Anesthesia myTIPreport: A Web-Based Tool for Real-Time Evaluation of Accreditation Council for Graduate Medical Education’s Milestone Competencies and Clinical Feedback to Residents. A A Pract 2019; 12:412-415. [DOI: 10.1213/xaa.0000000000000976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chen F, Lui AM, Martinelli SM. In response to Vanneman et al. on 'Studies on the effectiveness of flipped classrooms'. Med Educ 2018; 52:877. [PMID: 29992691 DOI: 10.1111/medu.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Fei Chen
- Department of Anaesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela M Lui
- Department of Educational and Counselling Psychology, State University of New York at Albany, Albany, New York, USA
| | - Susan M Martinelli
- Department of Anaesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
The mitral valve remains a complex structure where multiple forms of pathology can be seen. Mitral regurgitation continues to be one of the most common valvular diseases in the industrialized world. While intraoperative 2-dimensional transesophageal echocardiography has been commonplace for some time, 3-dimensional technology has emerged and has shown great benefit for diagnosis and guidance during mitral valve surgery. In the hands of a trained sonographer, high-quality real-time images can easily be obtained and correlate well with gross anatomical findings. The use of multiple angled views and color Doppler within 3-dimensional transesophageal echocardiography has become a valuable asset in the understanding and interpretation of the mitral valve for surgical interventions.
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Affiliation(s)
- Meena Bhatia
- 1 University of North Carolina, Chapel Hill, NC, USA
| | - Priya Kumar
- 1 University of North Carolina, Chapel Hill, NC, USA
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Isaak R, Stiegler M, Hobbs G, Martinelli SM, Zvara D, Arora H, Chen F. Comparing Real-time Versus Delayed Video Assessments for Evaluating ACGME Sub-competency Milestones in Simulated Patient Care Environments. Cureus 2018; 10:e2267. [PMID: 29736352 PMCID: PMC5935426 DOI: 10.7759/cureus.2267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Simulation is an effective method for creating objective summative assessments of resident trainees. Real-time assessment (RTA) in simulated patient care environments is logistically challenging, especially when evaluating a large group of residents in multiple simulation scenarios. To date, there is very little data comparing RTA with delayed (hours, days, or weeks later) video-based assessment (DA) for simulation-based assessments of Accreditation Council for Graduate Medical Education (ACGME) sub-competency milestones. We hypothesized that sub-competency milestone evaluation scores obtained from DA, via audio-video recordings, are equivalent to the scores obtained from RTA. Methods Forty-one anesthesiology residents were evaluated in three separate simulated scenarios, representing different ACGME sub-competency milestones. All scenarios had one faculty member perform RTA and two additional faculty members perform DA. Subsequently, the scores generated by RTA were compared with the average scores generated by DA. Variance component analysis was conducted to assess the amount of variation in scores attributable to residents and raters. Results Paired t-tests showed no significant difference in scores between RTA and averaged DA for all cases. Cases 1, 2, and 3 showed an intraclass correlation coefficient (ICC) of 0.67, 0.85, and 0.50 for agreement between RTA scores and averaged DA scores, respectively. Analysis of variance of the scores assigned by the three raters showed a small proportion of variance attributable to raters (4% to 15%). Conclusions The results demonstrate that video-based delayed assessment is as reliable as real-time assessment, as both assessment methods yielded comparable scores. Based on a department’s needs or logistical constraints, our findings support the use of either real-time or delayed video evaluation for assessing milestones in a simulated patient care environment.
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Affiliation(s)
- Robert Isaak
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Marjorie Stiegler
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Gene Hobbs
- Department of Neurosurgery, University of North Carolina School of Medicine
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - David Zvara
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina School of Medicine
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Martinelli SM, Chen F, Hobbs G, Chidgey BA, Straube LE, Zvara D, Isaak R. The Use of Simulation to Improve Family Understanding and Support of Anesthesia Providers. Cureus 2018; 10:e2262. [PMID: 29725565 PMCID: PMC5931409 DOI: 10.7759/cureus.2262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/02/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Burnout in medical providers is associated with work dissatisfaction, reduction in patient safety, and provider depression. Simulation is a tool effectively used for specific task training but has not been broadly used as a means to combat medical professional stress and enhance wellness. The authors created a medical simulation program targeted at those involved in the social support of medical providers. The hypothesis was that education of non-medical persons involved in social support would translate into an enhanced understanding of the demands among medical providers in anesthesiology. This understanding would thereby open communication pathways within the social support system and contribute to enhanced wellness among providers. Methods To assess effectiveness and benefits of the event, survey data were obtained from anesthesia providers and their adult support persons before and after the event. The anesthesia providers were queried on their perception regarding the benefit of the event for their support persons. Support persons were asked questions regarding their understanding of the role of an anesthesia provider. Results Sixty-three family members and friends (adult=30, child=33) participated in a two-hour simulation event including activities for participants of all ages. Twenty-nine (96.7%) adult participants (age ≥ 14) completed the support person surveys before and/or after the event. The post-event survey results revealed participants' satisfaction with the event (n=26, 100%). This simulation event also demonstrated an improved understanding of the demands among anesthesia providers by their support persons (seven items, P values range from less than .0001 to .0313). Most anesthesia providers who attended the event enjoyed it a significant amount (n=19, 82.6%). Most providers whose primary work-related support persons attended the event believed that it would be easier to communicate work-related issues (n=12, 85.7%). Conclusion We outline "The Family Anesthesia Experience Day" as a wellness initiative for anesthesia providers. Our study demonstrated improved understanding of support persons' knowledge about anesthesia providers' work-related stress via an immersive two-hour simulation-based learning experience. The event was well-received and may be a useful approach to provide support persons with an opportunity to learn about and better support their beloved anesthesia provider.
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Affiliation(s)
- Susan M Martinelli
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Gene Hobbs
- Department of Neurosurgery, University of North Carolina School of Medicine
| | - Brooke A Chidgey
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Lacey E Straube
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - David Zvara
- Department of Anesthesiology, University of North Carolina School of Medicine
| | - Robert Isaak
- Department of Anesthesiology, University of North Carolina School of Medicine
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Martinelli SM, Chen F, Mcevoy MD, Zvara DA, Schell RM. Utilization of the Flipped Classroom in Anesthesiology Graduate Medical Education: An Initial Survey of Faculty Beliefs and Practices About Active Learning. J Educ Perioper Med 2018; 20:E617. [PMID: 29928664 PMCID: PMC5991778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Flipped classroom (FC) is an active learning (AL) technique thought to have potential benefits in anesthesiology resident education. This survey aimed to determine the frequency of FC utilization, barriers of utilization, and means to overcome these barriers. METHOD A web-based questionnaire was developed to survey anesthesiology faculty on their knowledge of and experience with FC. The Society of Academic Associations of Anesthesiology and Perioperative Medicine sent the survey to all United States core program directors (PD) via their list serve with a request for the PDs to forward the survey invitation to their clinical faculty. Descriptive statistics were summarized. RESULTS A total of 244 anesthesiology faculty completed the survey. Reported faculty understanding of AL and FC were 57%. Of these faculty, 87% utilized AL and 57% utilized FC in their personal teaching practice during the past year (spring 2015-spring 2016). The most prevalent barriers to utilization of FC were faculty concern that learners would not come to class prepared or participate in class, faculty comfort with delivering traditional lectures, lack of faculty knowledge of necessary technological tools, and faculty concern about perceived increase in time needed to create a FC session. Eighty-nine percent of all faculty desired education on FC with preference for institutional workshops or grand rounds. CONCLUSIONS Our survey found a discrepancy between faculty knowledge of FC and usage of this method in anesthesiology resident teaching. More educational resources are warranted to address barriers and familiarize faculty with FC applications in anesthesiology resident education.
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Henley MD, Farber MA, Ikonomidis JS, Kolarczyk LM, Teeter EG, Barrick BP, Caranasos TG, Martinelli SM. A Tale of Three Surgeries: Management of a Massive Recurrent Mycotic Aortic Pseudoaneurysm. J Cardiothorac Vasc Anesth 2017; 32:550-557. [PMID: 29126684 DOI: 10.1053/j.jvca.2017.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Megan D Henley
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Mark A Farber
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S Ikonomidis
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lavinia M Kolarczyk
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily G Teeter
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian P Barrick
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thomas G Caranasos
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Karhausen JA, Smeltz AM, Akushevich I, Cooter M, Podgoreanu MV, Stafford-Smith M, Martinelli SM, Fontes ML, Kertai MD. Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery. Anesth Analg 2017. [PMID: 28632537 DOI: 10.1213/ane.0000000000002187] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated with stroke. METHODS We evaluated 6130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild versus moderate to severe) predictors of stroke. Extended Cox proportional hazard regression analysis with a time-varying covariate for daily minimum postoperative platelet count assessed the association of day-to-day variations in postoperative platelet count with time to stroke. Competing risks proportional hazard regression models examined associations between day-to-day variations in postoperative platelet counts with timing of stroke (early: 0-1 days; delayed: ≥2 days). RESULTS Median (interquartile range) postoperative nadir platelet counts were 123.0 (98.0-155.0) × 10/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts >150 × 10/L, 100 to 150 × 10/L, and <100 × 10/L, respectively. The risk for stroke increased by 12% on a given postoperative day for every 30 × 10/L decrease in platelet counts (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01-1.24; P= .0255). On a given day, patients with moderate to severe thrombocytopenia were almost twice as likely to develop stroke (adjusted HR, 1.89; 95% CI, 1.13-3.16; P= .0155) as patients with nadir platelet counts >150 × 10/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (≥2 days after surgery; adjusted HR, 2.83; 95% CI, 1.48-5.41; P= .0017) but not early postoperative stroke. CONCLUSIONS Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery.
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Affiliation(s)
- Jörn A Karhausen
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Alan M Smeltz
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Igor Akushevich
- Center for Population Health and Aging, Duke University Medical Center, Durham, North Carolina
| | - Mary Cooter
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Mihai V Podgoreanu
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Mark Stafford-Smith
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Manuel L Fontes
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut
| | - Miklos D Kertai
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
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Chen F, Arora H, Martinelli SM. Use of Key Performance Indicators to Improve Milestone Assessment in Semi-Annual Clinical Competency Committee Meetings. J Educ Perioper Med 2017; 19:E611. [PMID: 29766033 PMCID: PMC5944405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education's Next Accreditation System requires residency programs to semiannually submit composite milestone data on each resident's performance. This report describes and evaluates a new assessment review procedure piloted in our departmental Clinical Competency Committee (CCC) semi-annual meeting in June 2016. METHODS A modified Delphi technique was utilized to develop key performance indicators (KPI) linking milestone descriptors to clinical practice. In addition, the CCC identified six specific milestone sub-competencies that would be prescored with objective data prior to the meeting. Each resident was independently placed on the milestones by 3 different CCC faculty members. Milestone placement data of the same cohort of 42 residents (Clinical Anesthesia Years 1-3) were collected to calculate inter-rater reliability of the assessment procedures before and after the implemented changes. A survey was administrated to collect CCC feedback on the new procedure. RESULTS The procedure assisted in reducing meeting time from 8 to 3.5 hours. Survey of the CCC members revealed positive perception of the procedure. Higher inter-rater reliability of the milestone placement was obtained using the implemented KPIs (Intraclass correlation coefficient [ICC] single measure range: before=.53-.94, after=.74-.98). CONCLUSION We found the new assessment procedure beneficial to the efficiency and transparency of the assessment process. Further improvement of the procedure involves refinement of KPIs and additional faculty development on KPIs to allow non-CCC faculty to provide more accurate resident evaluations.
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Martinelli SM. Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents. J Grad Med Educ 2017; 9:485-490. [PMID: 28824763 PMCID: PMC5559245 DOI: 10.4300/jgme-d-17-00128.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In a flipped classroom approach, learners view educational content prior to class and engage in active learning during didactic sessions. OBJECTIVE We hypothesized that a flipped classroom improves knowledge acquisition and retention for residents compared to traditional lecture, and that residents prefer this approach. METHODS We completed 2 iterations of a study in 2014 and 2015. Institutions were assigned to either flipped classroom or traditional lecture for 4 weekly sessions. The flipped classroom consisted of reviewing a 15-minute video, followed by 45-minute in-class interactive sessions with audience response questions, think-pair-share questions, and case discussions. The traditional lecture approach consisted of a 55-minute lecture given by faculty with 5 minutes for questions. Residents completed 3 knowledge tests (pretest, posttest, and 4-month retention) and surveys of their perceptions of the didactic sessions. A linear mixed model was used to compare the effect of both formats on knowledge acquisition and retention. RESULTS Of 182 eligible postgraduate year 2 anesthesiology residents, 155 (85%) participated in the entire intervention, and 142 (78%) completed all tests. The flipped classroom approach improved knowledge retention after 4 months (adjusted mean = 6%; P = .014; d = 0.56), and residents preferred the flipped classroom (pre = 46%; post = 82%; P < .001). CONCLUSIONS The flipped classroom approach to didactic education resulted in a small improvement in knowledge retention and was preferred by anesthesiology residents.
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Chen F, Martinelli SM, Arora H. Overnight call and cognitive functioning: Will tablet-based assessment be the solution for safety check in residents? J Clin Anesth 2017. [DOI: 10.1016/j.jclinane.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Isaak RS, Chen F, Arora H, Martinelli SM, Zvara DA, Stiegler MP. A Descriptive Survey of Anesthesiology Residency Simulation Programs: How Are Programs Preparing Residents for the New American Board of Anesthesiology APPLIED Certification Examination? Anesth Analg 2017. [PMID: 28632531 DOI: 10.1213/ane.0000000000002189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiology residency programs may need new simulation-based programs to prepare residents for the new Objective Structured Clinical Examination (OSCE) component of the American Board of Anesthesiology (ABA) Primary Certification process. The design of such programs may require significant resources, including faculty time, expertise, and funding, as are currently needed for structured oral examination (SOE) preparation. This survey analyzed the current state of US-based anesthesiology residency programs regarding simulation-based educational programming for SOE and OSCE preparation. METHODS An online survey was distributed to every anesthesiology residency program director in the United States. The survey included 15 to 46 questions, depending on each respondent's answers. The survey queried current practices and future plans regarding resident preparation specifically for the ABA APPLIED examination, with emphasis on the OSCE. Descriptive statistics were summarized. χ and Fisher exact tests were used to test the differences in proportions across groups. Spearman rank correlation was used to examine the association between ordinal variables. RESULTS The responding 66 programs (49%) were a representative sample of all anesthesiology residencies (N = 136) in terms of geographical location (χ P = .58). There was a low response rate from small programs that have 12 or fewer clinical anesthesia residents. Ninety-one percent (95% confidence interval [CI], 84%-95%) of responders agreed that it is the responsibility of the program to specifically prepare residents for primary certification, and most agreed that it is important to practice SOEs (94%; 95% CI, 88%-97%) and OSCEs (89%; 95% CI, 83%-94%). While 100% of respondents reported providing mock SOEs, only 31% (95% CI, 24%-40%) of respondents provided mock OSCE experiences. Of those without an OSCE program, 75% (95% CI, 64%-83%) reported plans to start one. The most common reasons for not having an OSCE program already in place, and the perceived challenges for implementing an OSCE program, were the same: lack of time (faculty and residents), expertise in OSCE development and assessment, and funding. CONCLUSIONS The results provide data from residency programs for benchmarking their simulation curriculum and ABA APPLIED Examination preparation offerings. Despite agreement that residency programs should prepare residents for the ABA APPLIED Examination, many programs have yet to implement an OSCE preparation program, in part due to lack of financial resources, faculty expertise, and time. Additionally, in contrast to the SOE, the OSCE is a new format for ABA primary certification. As a result, the lack of consensus concerning preparation needs could be related to the amount information that is available regarding the examination content and assessment process.
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Affiliation(s)
- Robert S Isaak
- From the Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Chen F, Lui AM, Martinelli SM. A systematic review of the effectiveness of flipped classrooms in medical education. Med Educ 2017; 51:585-597. [PMID: 28488303 DOI: 10.1111/medu.13272] [Citation(s) in RCA: 311] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/09/2016] [Accepted: 01/04/2017] [Indexed: 05/02/2023]
Abstract
CONTEXT There are inconsistent claims made about the effectiveness of the flipped classroom (FC) in medical education; however, the quality of the empirical evidence used to back up these claims is not evident. The aims of this review are to examine the scope and quality of studies on the FC teaching approach in medical education and to assess the effects of FCs on medical learning. METHODS A literature search was conducted using the major electronic databases in 2016. Peer-reviewed papers were screened and reviewed according to explicit inclusion criteria. The scope and quality of all resultant studies were evaluated. Studies identified as using controlled designs were further synthesised to assess the effects of FCs on learning. RESULTS A total of 118 articles were obtained. Full texts of 82 articles were reviewed. Nine of the included 46 articles used a controlled design when examining the effects of the FC. There were generally positive perceptions of the FC approach. However, the effects of FCs on changes in knowledge and skills were less conclusive as the effect sizes ranged from d = -0.27 to 1.21, with a median of 0.08. The varying direction and magnitude of the effect sizes, together with their 95% confidence interval, which contained zero, suggested the lack of strong evidence for the effectiveness of FCs in promoting knowledge acquisition above and beyond the traditional learning methods. CONCLUSIONS There has been a recent increase of research rigor and variety in measures of effectiveness in studies on the FC in medical education. The FC is a promising teaching approach to increase learners' motivation and engagement. More solid evidence on its effect on changes in knowledge and skills are warranted. Further studies should also examine the long-term effects of FCs with regard to knowledge retention and transfer of knowledge to professional practice and patient care.
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Affiliation(s)
- Fei Chen
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela M Lui
- University at Albany, The State University of New York, Albany, New York, USA
| | - Susan M Martinelli
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Chen F, Arora H, Martinelli SM, Teeter E, Mayer D, Zvara DA, Passannante A, Smith KA. The predictive value of pre-recruitment achievement on resident performance in anesthesiology. J Clin Anesth 2017; 39:139-144. [PMID: 28494890 DOI: 10.1016/j.jclinane.2017.03.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/24/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Selecting candidates for residency positions is challenging and there is little research on the correlation between commonly used selection criteria and subsequent performance in anesthesiology. This study examined the association between the selection measures and post-recruitment performance in residency. DESIGN Retrospective review of archival data. SETTING Anesthesiology residency program at a large academic anesthesiology department. SUBJECTS Residents who were matched to the anesthesiology program over 9years (graduation classes of 2006 to 2014). INTERVENTIONS None. MEASUREMENTS The pre-recruitment achievements included a comprehensive list of measures obtained from residents' application portfolios in conjunction with interview performance. The post-recruitment examination outcomes consisted of the in-training examination (ITE) scores in the three clinical anesthesia (CA) years and first-attempt success on the written board certification examination administered by the American Board of Anesthesiology (ABA). Scholarly output during residency was measured by publication record. Clinical performance at the conclusion of residency was independently rated by three faculty members. Bivariate analysis and regression models were conducted to examine association between predictors and outcomes. MAIN RESULTS High United States Medical Licensing Examination (USMLE) scores, class rank in medical school and interview performance were predictive of high examination scores in residency and good clinical performance. Class rank appeared to be the best predictor of scholarly publication and pursuing an academic career beyond residency. CONCLUSIONS Comparative performance with classmates (i.e., class rank) in medical school appeared to be an effective predictor of overall performance in residency, which warrants more attention in future study. Although interview performance is subject to recruitment team members' interpretation, it is an important measure to include in recruitment decisions.
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Affiliation(s)
- Fei Chen
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - Harendra Arora
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - Susan M Martinelli
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - Emily Teeter
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - David Mayer
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - David A Zvara
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - Anthony Passannante
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
| | - Kathleen A Smith
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, N2198, CB7010, UNC Hospitals, Chapel Hill, NC 27599-7010, United States.
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Martinelli SM, Lobonc A, Wallen EM, Stansfield WE, Selph JP, Calvo B, Kumar PA. Combined Aortic Valve Replacement and Renal Cell Carcinoma Thrombectomy. Semin Cardiothorac Vasc Anesth 2016; 21:95-98. [PMID: 26620136 DOI: 10.1177/1089253215616498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although nephrectomy for renal cell carcinoma with inferior vena cava invasion is a common procedure, it is rare to have level IV invasion necessitating cardiopulmonary bypass (CPB). Furthermore, it is exceptionally rare to perform cardiac surgery concomitantly with this resection. We report a case in which an aortic valve replacement was done in the same surgical setting as a level IV thrombectomy. We have demonstrated that although it can be difficult to manage the coagulopathy post-CPB, this can be successfully accomplished with adequate prior preparation and a coordinated team effort.
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Affiliation(s)
| | - Andrew Lobonc
- 1 University of North Carolina, Chapel Hill, NC, USA
| | - Eric M Wallen
- 1 University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - Priya A Kumar
- 1 University of North Carolina, Chapel Hill, NC, USA.,3 Outcomes Research Consortium, Cleveland, OH, USA
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Teeter EG, Barrick BP, Kumar PA, Haithcock BE, Karenz AR, Martinelli SM. Anesthetic Management of a Patient With Situs Inversus for Bilateral Orthotopic Lung Transplantation. J Cardiothorac Vasc Anesth 2016; 30:1641-1644. [PMID: 27179614 DOI: 10.1053/j.jvca.2016.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Benjamin E Haithcock
- Department of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Asgarian CD, Martinelli SM, Mark JB, Kumar PA. Partial Anomalous Hepatic Venous Return: A Systematic Intraoperative Exclusion of Other Serious Diagnoses. Anesth Analg 2016; 122:349-53. [PMID: 26797550 DOI: 10.1213/ane.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Camellia D Asgarian
- From the *Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; †Department of Anesthesiology, Duke University Medical Center, Anesthesiology Service, Veterans Affairs Medical Center, Durham, North Carolina; and ‡Outcomes Research Consortium, Cleveland, Ohio
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Abstract
A double-walled interatrial septum is a rare congenital cardiac anomaly characterized by a distinct echolucent cavity between the atria formed by 2 separate interatrial septae. It may be a variant of other well-recognized cardiac anomalies such as persistent venous valve of the sinus venosus or cor triatriatum. Although uncommon, it may be associated with thromboembolic disease due to stagnant flow in the septal cavity. Awareness of this rare entity and its clinical significance along with a thorough echocardiographic examination to rule out similarly presenting or coexisting conditions are the key to an accurate diagnosis and appropriate management.
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Affiliation(s)
- Priya A. Kumar
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Susan M. Martinelli
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert W. Kyle
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
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Martinelli SM, McGraw KA, Kalbaugh CA, Vance S, Viera AJ, Zvara DA, Mayer DC. A Novel Core Competencies-Based Academic Medicine Curriculum: Description and Preliminary Results. J Educ Perioper Med 2014; 16:E076. [PMID: 27175398 PMCID: PMC4719544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Physicians practice health care in a rapidly changing system that requires more than the delivery of safe and effective care. Modern physicians must also acquire skills beyond direct patient care. Residency programs must, therefore, prepare physicians to meet these demands by providing appropriate education and training. METHODS We designed, implemented and assessed an academic medicine curriculum in the first post-graduate year. This curriculum provides comprehensive exposure to necessary non-patient contact related physician skills. Topics centered around four domains: critical appraisal of literature of literature, quality improvement, professional development, and teaching. Each of these domains is linked to the six core competencies established by the Accreditation Council for Graduate Medical Education's (ACGME). Instruction includes small-group learning sessions with additional time for self-directed online modules and a faculty-mentored quality improvement research project that is presented at a graduation symposium. All residents completed a survey evaluation of the curriculum before and after the course via open-ended questions and Likert responses (0-5). We assessed improvement in resident confidence with each curricular domain using mean Likert score change and 95% confidence intervals (CI). RESULTS Residents improved at all curricular domains measured. The most significant mean changes included confidence in: poster presentations (2.7; 95% CI: 1.9-3.5), plan-do-check-act cycle (2.5; 95% CI: 2.1-2.9), quality improvement projects (2.4; 95% CI: 1.9-2.9), and abstract presentation (2.3; 95% CI: 1.6-3.0). CONCLUSIONS We found that the academic medicine rotation (AMR) is feasible in a large academic setting. Furthermore, the AMR allows early exposure to and improvement in essential non-patient contact related physician skills required by the ACGME core competencies and assessed through the milestones.
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Affiliation(s)
- Susan M. Martinelli
- Assistant Professor, Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill
| | - Kathleen A. McGraw
- Librarian, Health Sciences Library, University of North Carolina at Chapel Hill
| | - Corey A. Kalbaugh
- Doctoral Student, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Stephen Vance
- Medical Student, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony J. Viera
- Distinguished Associate Professor, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - David A. Zvara
- Professor, Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill
| | - David C. Mayer
- Professor, Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill
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Joseph JA, Terry CM, Waller EJ, Bortsov AV, Zvara DA, Mayer DC, Martinelli SM. Enhancement of anesthesiology in-training exam performance with institution of an academic improvement policy. J Educ Perioper Med 2014; 16:E072. [PMID: 27175403 PMCID: PMC4719554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Anesthesiology resident physicians across the United States complete an annual in-training examination (ITE). The ITE evaluates resident knowledge and provides personalized feedback to guide future study in low scoring sections(1). Performance on the ITE correlates with outcomes on the American Board of Anesthesiology (ABA) written board examination(2). Over the last several years, declining ITE scores were observed at the University of North Carolina (UNC). In response to this decline, our department reprioritized the ITE by instituting an academic improvement policy (AIP). The AIP employed both reward for satisfactory achievement and consequence for under-performance to elevate the ITE as a "high stakes" examination. Our hypothesis was that implementation of this AIP would improve ITE scores. METHODS ITE scores were compiled from 150 residents in the Department of Anesthesiology at UNC for graduating classes from 2004-2015. Data is presented as the number of residents scoring below the 20th percentile when compared to the national distribution before and after the AIP. In addition, average USMLE Step 1 three-digit scores for each graduating class were compared to average ITE percentile scores of the corresponding graduating class (USMLE does not provide percentile scores). RESULTS Between 2009 and 2013, the number of residents who scored below the 20th percentile on the ITE increased steadily to a peak of 10 in 2011. After implementation of the AIP in July 2011, there was an 80% decrease in those scoring below the 20th percentile, from 10 to 2 residents (p<0.05). CONCLUSIONS Anesthesiology resident ITE scores improved after implementation of an academic improvement policy.
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Affiliation(s)
- Julie A. Joseph
- Anesthesiology Resident, University of North Carolina School of Medicine
| | - Chris M. Terry
- Anesthesiology Resident, University of North Carolina School of Medicine
| | - Eva J. Waller
- Anesthesiology Resident, University of North Carolina School of Medicine
| | - Andrey V. Bortsov
- Assistant Professor, Department of Anesthesiology, University of North Carolina School of Medicine
| | - David A. Zvara
- Professor, Department of Anesthesiology, University of North Carolina School of Medicine
| | - David C. Mayer
- Professor, Department of Anesthesiology, University of North Carolina School of Medicine
| | - Susan M. Martinelli
- Assistant Professor, Department of Anesthesiology, University of North Carolina School of Medicine
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Kumar PA, Graybill M, Chidgey B, Martinelli SM, Arora H. An Incidental Discovery or an Impending Disaster in a Patient With Coronary Artery Disease? J Cardiothorac Vasc Anesth 2012; 26:349-51. [DOI: 10.1053/j.jvca.2010.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Indexed: 12/20/2022]
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Martinelli SM, Monroe H, Coombs R, Miller N, Borstov A, Salo-Coombs V. Assessing the Impact of a Regional Anesthesia Workshop on Anesthesiology Residents' Perceived Comfort in Performing Peripheral Nerve Blocks. J Educ Perioper Med 2012; 14:E061. [PMID: 27175392 PMCID: PMC4719547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Different methods of regional anesthesia education have been described in the literature, but none have proven to be superior. The objective of this study was to evaluate the educational value as perceived by the anesthesia resident of a regional anesthesia workshop. METHODS Twenty-eight anesthesia residents participated in a workshop, which reviewed nerve blocks of the upper and lower extremities. Prior to the workshop, each resident completed a survey assessing their confidence in their ability to perform 13 nerve blocks. At the conclusion of the workshop and at 3 months post-workshop, the residents completed similar surveys. Paired sample t-test was used to compare pre- and post-workshop confidence levels. RESULTS Twenty-eight residents completed the pre-, post-, and 3-month follow-up questionnaires. There was a statistically significant increase in residents' confidence level post-workshop for 11 block s evaluated. This was sustained in 5 blocks at the 3 month follow-up survey. Senior residents had higher baseline confidence scores when compared to junior residents. When all blocks were considered, junior residents demonstrated a statistically signifi cant increase in confidence level in independently performing nerve blocks immediately post workshop and at 3 month follow-up. Senior residents had a statistically significant increase in confidence level immediately post workshop, but not at the 3 month follow-up. 100% of participants found the workshop to be beneficial. Participants with less prior experience showed sustained increase in comfort levels at 3 months post-workshop (p=0.007). CONCLUSIONS Based on self-reported trainee comfort level, the workshop was an effective teaching tool. Future workshops might be most effective when targeted at learners with less baseline regional anesthesia experience. Peripheral nerve block workshops can provide an important adjunct in the regional anesthesia ed ucation of resident anesthesiologists.
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Affiliation(s)
- Susan M. Martinelli
- Cardiothoracic Anesthesiology Fellowship ’08, Department of Anesthesiology, University of North Carolina , Chapel Hill, NC
| | - Hanni Monroe
- Regional Anesthesia Fellowship (will complete ’12) Duke University Medical Center, Durham, NC
| | - Randall Coombs
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Natalie Miller
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Andrey Borstov
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
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Martinelli SM, Patel UD, Phillips-Bute BG, Milano CA, Archer LE, Stafford-Smith M, Shaw AD, Swaminathan M. Trends in cardiac surgery-associated acute renal failure in the United States: a disproportionate increase after heart transplantation. Ren Fail 2010; 31:633-40. [PMID: 19814629 DOI: 10.3109/08860220903100689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acute renal failure (ARF) is common after cardiac surgery and more frequent after complex cardiac surgery. While the incidence of ARF is increasing after coronary artery bypass graft (CABG) surgery, trends in other forms of cardiac surgery remain unclear. We investigated the trend of ARF in various cardiac procedures and compared patterns using CABG surgery as a reference group. The study population consisted of discharges from the Nationwide Inpatient Sample from 1988 to 2003, grouped according to surgery as: CABG, CABG with mitral valve, CABG with other valve, valve alone, and heart transplant. Standard diagnostic codes were used to identify ARF among discharges. Multivariable regression was used to determine trends in ARF among various procedures with CABG as a reference group. The incidence of ARF increased in all five groups (p < 0.001) over the 16-year period. The ARF incidence was highest in the heart transplant group (17%). Compared to the CABG population, patients following heart transplantation developed ARF at higher rates during the study period. In contrast, while ARF increased over time in other groups, the rates of rise were slower than in CABG patients. Among heart surgery procedures, ARF incidence is highest in heart transplantation. The incidence of ARF is also increasing at a faster rate in this group of patients in contrast to other procedure groups when compared to CABG surgery. The disproportionate increase in ARF burden after heart transplantation is a concern due to its strong association with chronic kidney disease and mortality.
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Affiliation(s)
- Susan M Martinelli
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Martinelli SM, Mitchell JD, McCann RL, Podgoreanu MV, Mathew JP, Swaminathan M. Intraoperative Transesophageal Echocardiography Diagnosis of Residual Tumor Fragment After Surgical Removal of Renal Cell Carcinoma. Anesth Analg 2008; 106:1633-5. [DOI: 10.1213/ane.0b013e3181734147] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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