Four-Year Analysis of a Novel Milestone-Based Assessment of Faculty by General Surgical Residents.

OBJECTIVE: In response to our faculty's concerns about the quality and reliability of feedback from general surgery residents, we developed a novel faculty assessment tool. This study was designed as an interim analysis of the tool's effectiveness and discriminatory ability. METHODS: Our department's educational leadership developed milestones in 7 domains that were scored from 1 to 4, with each level representing an educational approach that ranged from ineffective (1) to ideal (4). Each postgraduate year (PGY) class meets annually to develop a consensus regarding each faculty member's effectiveness in each of the 7 domains: (1) operative supervision, (2) operative teaching, (3) clinic and/or hospital supervision, (4) clinic and/or hospital teaching, (5) conference participation, (6) availability, and (7) overall contribution to the training program. We reviewed the results from the initial 4 years of this project. We also analyzed the annual national faculty survey administered by the Accreditation Council for Graduate Medical Education (ACGME) to evaluate faculty satisfaction regarding feedback during the same study period. Data were assessed using the Levene test for homogeneity, analysis of variance, and Wilcoxon-Mann-Whitney tests. RESULTS: Forty-two faculty members were annually evaluated by 29 to 32 residents. Each resident PGY class assigned faculty milestone scores that varied across the 7 domains, demonstrating that faculty scores reflected variable opinions about each specific domain, while avoiding labeling an effective faculty member with all high scores and a less effective member with all poor scores.(p < 0.0001). Milestone scores for a given faculty member differed across PGY classes, indicating that junior residents might evaluate a specific faculty member differently than senior residents (p < 0.0001). Eleven faculty members received low scores of 1 or 2 on the overall contribution to training domain and 8/11 (73%) improved to 3 or 4, the following year. Twenty core faculty members were included on the annual ACGME survey. The results from the study period on the ACGME anonymous faculty survey reflected enhanced satisfaction with resident feedback during the study period, improving from 68% to 88% compliance with ACGME standards and our mean program score improved from 4.1 to 4.4 compared to the national mean of 4.3 (p = 0.02). CONCLUSIONS: This milestone-based faculty assessment tool improves the quality of the feedback from surgical residents when evaluating faculty. When residents assign a negative statement to describe faculty educational effectiveness in a specific domain, performance improves. A milestone-based faculty assessment strategy should be explored on a national level.

Shaker-related potassium channels in the central medial nucleus of the thalamus are important molecular targets for arousal suppression by volatile general anesthetics.

The molecular targets and neural circuits that underlie general anesthesia are not fully elucidated. Here, we directly demonstrate that Kv1-family (Shaker-related) delayed rectifier K(+) channels in the central medial thalamic nucleus (CMT) are important targets for volatile anesthetics. The modulation of Kv1 channels by volatiles is network specific as microinfusion of ShK, a potent inhibitor of Kv1.1, Kv1.3, and Kv1.6 channels, into the CMT awakened sevoflurane-anesthetized rodents. In heterologous expression systems, sevoflurane, isoflurane, and desflurane at subsurgical concentrations potentiated delayed rectifier Kv1 channels at low depolarizing potentials. In mouse thalamic brain slices, sevoflurane inhibited firing frequency and delayed the onset of action potentials in CMT neurons, and ShK-186, a Kv1.3-selective inhibitor, prevented these effects. Our findings demonstrate the exquisite sensitivity of delayed rectifier Kv1 channels to modulation by volatile anesthetics and highlight an arousal suppressing role of Kv1 channels in CMT neurons during the process of anesthesia.