Medical students' perspectives on and understanding of anesthesiology: a Canadian cross-sectional survey.

PURPOSE: In Canada, three out of 17 medical schools do not mandate an anesthesia rotation in their clerkship curriculum. Understanding the effects of a mandatory anesthesiology rotation is important in determining its value to the specialty and guiding decision-making for medical educators. We sought to determine whether a mandatory anesthesia rotation affected students' understanding of anesthesiology, as well as their perspectives on anesthesia. METHODS: We conducted an anonymous cross-sectional survey of Canadian medical students graduating in 2021. Our survey consisted of 46 questions related to student's perspectives of anesthesiology, understanding of anesthesia, their interest in the specialty, and participant's demographics. This included 16 Likert-scale questions, 19 quiz-style questions, four free-text response questions, and seven demographics questions. The survey was hosted by SurveyMonkey® (SurveyMonkey Inc., San Mateo, CA, USA) and distributed to the participants by each individual institution. RESULTS: We collected a total of 331 responses across 13 different Canadian medical schools, representing a 17.3% response rate of students surveyed and 11.7% of all graduating medical Canadian students in 2021. A mandatory rotation in anesthesiology was associated with a more positive perspective (P = 0.01) but not understanding (P = 0.07) of the specialty. A mandatory rotation was not related to students' application to anesthesiology at a statistically significant level (P = 0.06). CONCLUSIONS: The results of this national survey study show the benefits of including a mandatory clerkship rotation in anesthesiology, namely on increasing positive perceptions of the specialty, while also revealing avenues for future research and insights on how to further optimize a mandatory anesthesiology rotation in clerkship.

RéSUMé: OBJECTIF: Au Canada, trois facultés de médecine sur 17 n'exigent pas de stage clinique en anesthésie dans leur programme. Il est important de comprendre les effets d'un stage obligatoire en anesthésiologie afin de déterminer sa valeur pour la spécialité et d'orienter la prise de décision en matière d'éducation médicale. Nous avons cherché à déterminer si un stage obligatoire en anesthésie affectait la compréhension de l'anesthésiologie par les étudiant·es, ainsi que leurs points de vue sur l'anesthésie. MéTHODE: Nous avons mené un sondage transversal anonyme auprès d'étudiant·es en médecine qui ont obtenu leur diplôme en 2021 au Canada. Notre sondage comportait 46 questions portant sur leur point de vue sur l'anesthésiologie, leur compréhension de l'anesthésie, leur intérêt pour la spécialité et les caractéristiques démographiques des personnes interrogées. Le sondage comprenait 16 questions sur l'échelle de Likert, 19 questions courtes de type quiz, quatre questions à réponse libre et sept questions démographiques. Le sondage était hébergé par SurveyMonkey® (SurveyMonkey Inc., San Mateo, Californie, États-Unis) et a été distribué aux participant·es par chaque institution. RéSULTATS: Nous avons recueilli un total de 331 réponses dans 13 facultés de médecine canadiennes différentes, ce qui représente un taux de réponse de 17,3 % des étudiant·es interrogé·es et de 11,7 % de tous les étudiant·es en médecine diplômé·es en 2021 au Canada. Un stage obligatoire en anesthésiologie était associé à une perspective plus positive (P = 0,01) mais pas à une meilleure compréhension (P = 0,07) de la spécialité. Un stage obligatoire n'était pas lié aux demandes d'admission en anesthésiologie à un niveau statistiquement significatif (P = 0,06). CONCLUSION: Les résultats de cette enquête nationale montrent les avantages de l'inclusion d'un stage obligatoire en anesthésiologie, notamment pour accroître les perceptions positives de la spécialité, tout en révélant des pistes de recherche futures et des idées sur la façon d'optimiser davantage un stage clinique obligatoire en anesthésiologie.

Undergraduate Learners' Receptiveness to Feedback in Medical Schools: A Scoping Review.

Feedback from educators to learners is considered an important element of effective learning in medical school. While early studies were focused on the processes of providing feedback, recent work has showed that factors related to how learners receive feedback seems to be equally important. Considering that the literature on this topic is new in medical education, and studies are diverse and methodologically variable, we sought to conduct a scoping review to map the articles on receptiveness to feedback, to provide an overview of its related factors, to identify the types of research conducted in this area, and to document knowledge gaps in the existing literature. Using the Joanna Briggs Institute scoping review methodology, we searched four databases (CINAHL, Ovid, PubMed, and Web of Science) and screened 9120 abstracts, resulting in 98 articles for our final analysis. In this sample, 80% of studies on the feedback receiver were published in the last 10 years, and there is a vast variation in the studies' methodologies. The main factors that affect medical students' receptiveness to feedback are students' characteristics, feedback content, educators' credibility, and the learning environment. Feedback literacy is a very recent and rarely used term in medical education; therefore, an important area for further investigation. Lastly, we identified some gaps in the literature that might guide future research, such as studying receptiveness to feedback based on academic seniority and feedback literacy's long-term impacts on learning. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01858-0.

Characteristics of good clinical teachers in anesthesiology from medical students' perspective: a qualitative descriptive study.

PURPOSE: Learning needs are influenced by the stage of learning and medical specialty. We sought to investigate the characteristics of a good clinical teacher in anesthesiology from the medical students' perspective. METHODS: We conducted a qualitative descriptive study to analyze written comments of medical students about their clinical teachers' performances. Our analysis strategy was the inductive content analysis method. The results are reported as a descriptive summary with major themes as the final product. RESULTS: Our study identified four themes. The first theme, teachers' individual characteristics, includes characteristics that are usually more related to students' subjective experiences and feelings. The second theme, teachers' characteristics that advance student learning, seems to be one of the most important contributions to learning because it increases the practice of procedural skills. The third theme, teachers' characteristics that prepare students for success, shows characteristics that facilitate students' learning by promoting a healthy and safe environment. Lastly, the fourth theme, characteristics related to teaching approaches, includes characteristics that can guide clinical teachers more objectively. CONCLUSION: Our analysis of the written comments of medical students identified many characteristics of a good clinical teacher that were organized in four different themes. These themes contribute to expand on existing understandings of clinical teaching in the anesthesiology clerkship environment, and add new interpretations that can be reflected upon and explored by other clinical educators.

RéSUMé: OBJECTIF: Les besoins d'apprentissage sont influencés par le stade d'apprentissage et la spécialité médicale. Nous avons cherché à étudier les caractéristiques d'un bon enseignant clinique en anesthésiologie selon la perspective des étudiants en médecine. MéTHODE: Nous avons mené une étude descriptive qualitative pour analyser les commentaires écrits des étudiants en médecine sur les performances de leurs enseignants cliniques. Notre stratégie d'analyse était la méthode inductive d'analyse de contenu. Les résultats sont présentés sous forme de résumé descriptif avec les principaux thèmes comme produit final. RéSULTATS: Notre étude a identifié quatre thèmes. Le premier thème, les caractéristiques individuelles des enseignants, comprend des caractéristiques qui sont habituellement davantage liées aux expériences subjectives et aux sentiments des étudiants. Le deuxième thème, les caractéristiques de l'enseignant qui font progresser l'apprentissage des étudiants, semble être l'une des contributions les plus importantes à l'apprentissage parce qu'elle augmente la pratique des compétences procédurales. Le troisième thème, les caractéristiques de l'enseignant qui préparent les étudiants à la réussite, présente des caractéristiques qui facilitent l'apprentissage des étudiants en favorisant un environnement sain et sécuritaire. Enfin, le quatrième thème, les caractéristiques liées aux approches pédagogiques, comprend des caractéristiques qui peuvent guider les enseignants cliniques de manière plus objective. CONCLUSION: Notre analyse des commentaires écrits des étudiants en médecine a identifié de nombreuses caractéristiques d'un bon enseignant clinique qui étaient organisées en quatre thèmes différents. Ces thèmes contribuent à élargir les connaissances existantes de l'enseignement clinique dans l'environnement de stage clinique en anesthésiologie et ajoutent de nouvelles interprétations qui peuvent inciter d'autres éducateurs cliniques à y réfléchir et à les explorer.

Maintenance of certification for practicing physicians: a review of current challenges and considerations.

Maintenance of certification (MOC) has become increasingly important in medicine to ensure maintenance of competence throughout a physician's career. This paper reviews current issues and challenges associated with MOC in medicine, including how to define medical competencies for practicing physicians, assessment, and how best to support physicians' lifelong learning in a continuous and self-motivated way. We explore how the combination of self-monitoring, regular feedback, and peer support could improve self-assessment. Effective MOC programs are learner-driven, focused on every day practice, and incorporate educational principles. We discuss the importance of MOC to the physicians' actual practice to improve acceptability. We review the benefits of tailored programs as well as decentralization of MOC programs to better characterize the physician's practice. Lastly, we discuss the value of simulation-based medical education in MOC programs. Simulation-based education could be used to practice uncommon complications, life-threatening scenarios, non-technical skills improvement, and become proficient with new technology. As learners find simulation experiences educationally valuable, clinically relevant, and positive, simulation could be a way of increasing physicians' participation in MOC programs.

Le maintien de la certification (MDC) revêt de plus en plus d'importance en médecine pour assurer le maintien des compétences tout au long de la carrière d'un médecin. Cet article examine les problèmes et les défis liés au MDC en médecine, notamment au chapitre de la définition descompétences médicales nécessaires aux médecins en pratique, de l'évaluation, et des meilleurs moyens d'appuyer la démarche d'apprenant à vie de façon continue et avec motivation intrinsèque. Nous explorons comment l'effet conjugué de l'autosurveillance, de la rétroaction régulière, et du soutien des pairs peut améliorer l'autoévaluation. Les programmes de MDC efficaces rendent l'apprenant actif, ciblés sur la pratique quotidienne, et ils intègrent également des principes d'enseignements. Afin d'améliorer l'acceptabilité, nous discutons de l'importance du MDC dans la pratique actuelle des médecins. Nous examinons les avantages liés aux programmes personnaliséset à la décentralisation des programmes MDC pour mieux caractériser la pratique du médecin. En dernier lieu, nous discutons de la valeur de l'enseignement par simulation dans les programmes de MDC. L'enseignement par simulation pourrait être utilisé pour pratiquer dans des contextes de complications rares ou de scénariosoù la vie du patient est menacée, à l'amélioration des compétences non techniques et à la maîtrise des nouvelles technologies. Avecles apprenants qui constatent que les expériences de simulations sont éducatives, cliniquement pertinentes et positives, celles-ci pourraient inciter les médecins à participer davantage aux programmes de MDC.

A literature review on observational learning for medical motor skills and anesthesia teaching.

Motor skill practice is very important to improve performance of medical procedures and could be enhanced by observational practice. Observational learning could be particularly important in the medical field considering that patients' safety prevails over students' training. The mechanism of observational learning is based on the mirror neuron system, originally discovered in the monkey pre-motor cortex. Today we know that humans have a similar system, and its role is to understand and reproduce the observed actions of others. Many studies conclude that humans are able to plan and to make movements based on visual information by mapping a representation of observed actions, especially when the motor system is committed to do it. Moreover most researchers considered observational learning effective for complex skills, such as medical procedures. Additionally, observational learning could play a relevant role during anesthesia training since the learner works in pairs most of the time (dyad practice). Some teaching approaches should be taken into consideration: an implicit engagement of the observer motor system is required, immediate feedback seems to have an important effect, and a combination of observational and physical practice could be better than physical practice alone. In an environment where effectiveness and efficacy are essential, observational learning seems to fit well.

Perioperative management of patients with obstructive sleep apnea: a survey of Canadian anesthesiologists.

INTRODUCTION: Obstructive sleep apnea (OSA) may increase the incidence of postoperative complications when undiagnosed. The purpose of this study was to evaluate the perspectives of Canadian anesthesiologists regarding the perioperative management of patients with diagnosed or suspected OSA. METHODS: This study was conducted as a survey of Canadian anesthesiologists using a self-administered scenario-based questionnaire. We initially mailed the survey questionnaire and then mailed it again to non-respondents six weeks later. Subsequently, we e-mailed the online version of our survey to active members of the Canadian Anesthesiologists' Society. RESULTS: The response rates were 35% and 26% for the postal and online modes of administration, respectively. About 50% of the respondents relied on clinical suspicion rather than on a systematic screening to identify patients who may have undiagnosed OSA preoperatively. Forty-seven percent of all respondents either did not know of any institutional policy to guide their perioperative management of patients with OSA or reported an absence of an institutional policy. Fifteen percent of the respondents would discharge diagnosed OSA inpatients with compliant use of continuous positive airway pressure (CPAP) to the ward without monitoring. Nevertheless, a more conservative approach was observed for CPAP non-compliant inpatients. We indeed observed that more than 40% of respondents would send an ambulatory OSA patient home, while another 60% would favour hospital admission. CONCLUSIONS: The majority of anesthesiologists continue to rely on clinical suspicion alone to identify OSA. Moreover, the lack of institutional policy is concerning. A concerted effort to develop an evidence-based guideline may be the next step to assist institutions.