Perceived Benefits and Barriers to a Career in Neuroanesthesiology: A Pilot Survey of Anesthesiology Clinicians.

BACKGROUND: Despite advances in perioperative neuroscience, there is low interest among anesthesiology trainees to pursue subspecialty training in neuroanesthesiology. We conducted a pilot survey to assess attitudes about neuroanesthesiology fellowship training. MATERIALS AND METHODS: A confidential survey was distributed to an international cohort of anesthesiology attendings and trainees between January 15, 2017 and February 26, 2017. RESULTS: A total of 463 responses were received. Overall, 309 (67%), 30 (6%), 116 (25%), and 8 (2%) of respondents identified themselves as attendings, fellows, residents, and "other," respectively. In total, 390 (84%) of respondents were from the United States. Individuals typically pursue anesthesiology fellowship training because of interest in the subspecialty, acquisition of a special skill set, and the role of fellowship training in career planning and advancement. Overall, 64% of attendings, 56% of fellows, and 55% of residents favored accreditation of neuroanesthesiology fellowships, although opinion was divided regarding the role of accreditation in increasing interest in the specialty. Respondents believe that increased opportunities for research and greater exposure to neurocritical care and neurological monitoring methods would increase interest in neuroanesthesiology fellowship training. Perceived barriers to neuroanesthesiology fellowship training were perceptions that residency provides adequate training in neuroanesthesiology, that a unique skill set is not acquired, and that there are limited job opportunities available to those with neuroanesthesiology fellowship training. CONCLUSIONS: In this pilot survey, we identified several factors that trainees consider when deciding to undertake subspecialty training and barriers that might limit interest in pursuing neuroanesthesiology subspecialty training. Our findings may be used to guide curricular development and identify factors that might increase interest among trainees in pursuing neuroanesthesiology fellowship training.

Using the healthcare matrix with interns and medical students as a tool to effect change.

The Healthcare Matrix is a tool developed at Vanderbilt University Medical Center which assesses the care of patients using the Accreditation Council for Graduate Medical Education (ACGME) competencies and the Institute of Medicine (IOM) Aims for Improvement. House staff have been using this tool since 2004 as a means of learning the competencies in the daily care of patients. As the residents fill in the cells of the Matrix, the opportunities for improvement become evident. Anesthesia interns were introduced to the Matrix at bimonthly meetings to analyze a real case of complex and/or flawed patient management. Each resident completed his/her own Matrix and then the group selected one Matrix as their improvement project. This article will present one Matrix case, how quality improvement (QI) tools and methods were utilized and what resulting improvements were made. The analyzed case revealed numerous flaws with nonstandardized handoffs, incorrect and insufficient documentation, and unclear roles/responsibilities. An ideal process flowchart was developed highlighting improved handoffs and the need for a new admitting policy to the intensive care unit (ICU). The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care. The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed. When taught the tools and methods of quality improvement, even interns can make a significant contribution to the improvement of patient care.