Procedure-Focused Escape Room: A Pilot Study on Teaching High-Stakes Technical Skills in Anesthesia Residents.

Background: High-stakes yet clinically infrequent procedures are challenging to teach. Escape rooms may offer an innovative solution through game-based learning. There is limited guidance on how to design an escape room focused on physical puzzles. We designed and implemented a procedure-focused escape room to teach high-stakes procedures to anesthesiology residents. Methods: We selected 5 procedural skills relevant to anesthesiology residents through a modified Delphi technique: fiberoptic intubation, rapid infuser setup, intraosseous line placement, flexible bronchoscopy, and supraglottic airway exchange. We designed associated skills stations and linked them in sequence using an elaborate series of puzzles, locks, keys, and codes. The total cost of puzzle equipment was $169.53. After pilot testing, we implemented the escape room from July to November 2022. We assessed residents using a single group pretest-posttest study design. Results: Forty-three of 55 (78%) eligible anesthesiology residents participated in the escape room. Thirty-one residents completed the surveys. Resident self-efficacy significantly improved for each of the 5 procedures. Twenty-six of 27 (96%) residents preferred the escape room over a typical procedural skills workshop. Conclusions: This pilot study demonstrated the feasibility of a procedure-focused escape room for teaching high-stakes technical skills. We identified 3 lessons in procedure-focused escape room design: set participant caps intentionally, optimize resource usage, and maximize reproducibility. Participating in a single escape room session significantly increased resident self-efficacy. Residents strongly preferred the escape room format over a traditional procedural skills workshop.

Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions.

BACKGROUND: Global medical education is gradually moving toward more comprehensive implementations of a competency-based education (CBE) model. Elimination of standard time-based training and adoption of time-variable training (competency-based time-variable training [CB-TVT]) is one of the final stages of implementation of CBE. While CB-TVT has been implemented in some programs outside the United States, residency programs in the United States are still exploring this approach to training. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) are encouraging member boards and residency review committees to consider innovative ways programs could implement CB-TVT. The goals of this study were to (1) identify potential problems with the implementation of CB-TVT in anesthesiology residency training, (2) rank the importance of the problems and the perceived difficulty of solving them, and (3) develop proposed solutions to the identified problems. METHODS: Study participants were recruited from key stakeholder groups in anesthesiology education, including current or former program directors, department chairs, residents, fellows, American Board of Anesthesiology (ABA) board members, ACGME residency review committee members or ACGME leaders, designated institutional officials, residency program coordinators, clinical operations directors, and leaders of large anesthesiology community practice groups. This study was conducted in 2 phases. In phase 1, survey questionnaires were iteratively distributed to participants to identify problems with the implementation of CB-TVT. Participants were also asked to rank the perceived importance and difficulty of each problem and to identify relevant stakeholder groups that would be responsible for solving each problem. In phase 2, surveys focused on identifying potential solutions for problems identified in phase 1. RESULTS: A total of 36 stakeholders identified 39 potential problems, grouped into 7 major categories, with the implementation of CB-TVT in anesthesiology residency training. Of the 39 problems, 19 (48.7%) were marked as important or very important on a 5-point scale and 12 of 19 (63.2%) of the important problems were marked as difficult or very difficult to solve on a 5-point scale. Stakeholders proposed 165 total solutions to the identified problems. CONCLUSIONS: CB-TVT is a promising educational model for anesthesiology residency, which potentially results in learner flexibility, individualization of curricula, and utilization of competencies to determine learner advancement. Because of the potential problems with the implementation of CB-TVT, it is important for future pilot implementations of CB-TVT to document realized problems, efficacy of solutions, and effects on educational outcomes to justify the burden of implementing CB-TVT.

Postgraduate-Year-1 Residents' Perceptions of Social Media and Virtual Applicant Recruitment: Cross-sectional Survey Study.

BACKGROUND: The dissemination of information about residency programs is a vital step in residency recruitment. Traditional methods of distributing information have been printed brochures, websites, in-person interviews, and increasingly, social media. Away rotations and in-person interviews were cancelled, and interviews were virtual for the first time during the COVID-19 pandemic. OBJECTIVE: The purpose of our study was to describe postgraduate-year-1 (PGY1) residents' social media habits in regard to residency recruitment and their perceptions of the residency programs' social media accounts in light of the transition to virtual interviews. METHODS: A web-based 33-question survey was developed to evaluate personal social media use, perceptions of social media use by residency programs, and perceptions of the residency program content. Surveys were sent in 2021 to PGY1 residents at Mayo Clinic in Arizona, Florida, and Minnesota who participated in the 2020-2021 interview cycle. RESULTS: Of the 31 program directors contacted, 22 (71%) provided permission for their residents to complete the survey. Of 219 residents who received the survey, 67 (30%) completed the survey. Most respondents applied to a single specialty, and greater than 61% (41/67) of respondents applied to more than 30 programs. The social media platforms used most regularly by the respondents were Instagram (42/67, 63%), Facebook (36/67, 54%), and Twitter (22/67, 33%). Respondents used the program website (66/67, 99%), residents (47/67, 70%), and social media (43/67, 64%) as the most frequent resources to research programs. The most commonly used social media platforms to research programs were Instagram (38/66, 58%), Twitter (22/66, 33%), and Doximity (20/66, 30%). The type of social media post ranked as most interesting by the respondents was "resident life outside of the hospital." In addition, 68% (39/57) of the respondents agreed or strongly agreed that their perception of a program was positively influenced by the residency program's social media account. CONCLUSIONS: In this multispecialty survey of PGY1 residents participating in the 2020-2021 virtual interview season, respondents preferred Instagram to Twitter or Facebook for gathering information on prospective residency programs. In addition, the program website, current residents, and social media platforms were the top-ranked resources used by prospective applicants. Having an up-to-date website and robust social media presence, particularly on Instagram, may become increasingly important in the virtual interview environment.

Physician Identification Badges: A Multispecialty Quality Improvement Study to Address Professional Misidentification and Bias.

OBJECTIVE: To evaluate whether providing resident physicians with "DOCTOR" role identification badges would impact perceptions of bias in the workforce and alter misidentification rates. PARTICIPANTS AND METHODS: Between October 2019 and December 2019, we surveyed 341 resident physicians in the anesthesiology, dermatology, internal medicine, neurologic surgery, otorhinolaryngology, and urology departments at Mayo Clinic in Rochester, Minnesota, before and after an 8-week intervention of providing "DOCTOR" role identification badges. Differences between paired preintervention and postintervention survey answers were measured, with a focus on the frequency of experiencing perceived bias and role misidentification (significance level, α=.01). Free-text comments were also compared. RESULTS: Of the 159 residents who returned both the before and after surveys (survey response rate, 46.6% [159 of 341]), 128 (80.5%) wore the "DOCTOR" badge. After the intervention, residents who wore the badges were statistically significantly less likely to report role misidentification at least once a week from patients, nonphysician team members, and other physicians (50.8% [65] preintervention vs 10.2% [13] postintervention; 35.9% [46] vs 8.6% [11]; 18.0% [23] vs 3.9% [5], respectively; all P<.001). The 66 female residents reported statistically significantly fewer episodes of gender bias (65.2% [43] vs 31.8% [21]; P<.001). The 13 residents who identified as underrepresented in medicine reported statistically significantly less misidentification from patients (84.6% [11] vs 23.1% [3]; P=.008); although not a statistically significant difference, the 13 residents identifying as underrepresented in medicine also reported less misidentification with nonphysician team members (46.2% [6] vs 15.4% [2]; P=.13). CONCLUSION: Residents reported decreased role misidentification after use of a role identification badge, most prominently improved among women. Decreasing workplace bias is essential in efforts to improve both diversity and inclusion efforts in training programs.

The Anesthesiology Milestones 2.0: An Improved Competency-Based Assessment for Residency Training.

The evolution of medical education, from a time-based to a competency-based platform, began nearly 30 years ago and continues to slowly take shape. The development of valid and reproducible assessment tools is the first step. Medical educators across specialties acknowledge the challenges and remain motivated to develop a relevant, generalizable, and measurable system. The Accreditation Council for Graduate Medical Education (ACGME) remains committed to its responsibility to the public by assuring that the process and outcome of graduate medical education in the nation's residency programs produce competent, safe, and compassionate doctors. The Milestones Project is the ACGME's current strategy in the evolution to a competency-based system, which allows each specialty to develop its own set of subcompetencies and 5-level progression, or milestones, along a continuum of novice to expert. The education community has now had nearly 5 years of experience with these rubrics. While not perfect, Milestones 1.0 provided important foundational information and insights. The first iteration of the Anesthesiology Milestones highlighted some mismatch between subcompetencies and current and future clinical practices. They have also highlighted challenges with assessment and evaluation of learners, and the need for faculty development tools. Committed to an iterative process, the ACGME assembled representatives from stakeholder groups within the Anesthesiology community to develop the second generation of Milestones. This special article describes the foundational data from Milestones 1.0 that was useful in the development process of Milestones 2.0, the rationale behind the important changes, and the additional tools made available with this iteration.

Methods of Orienting New Anesthesiology Residents to the Operating Room Environment: A National Survey of Residency Program Directors.

BACKGROUND: The initial weeks of clinical anesthesiology are a formative period for new residents. Trainees may be clinically educated by a variety of individuals, and introductory didactic structure likely differs between institutions. This study was undertaken to define current orientation practices in US anesthesiology residency programs. METHODS: A survey was created using Qualtrics© software and distributed to all US anesthesiology residency program directors through the Society of Academic Associations of Anesthesiology & Perioperative Medicine email newsletter and through direct email to program directors. RESULTS: Fifty-six unique survey responses were received of 156 total programs. Eighty-nine percent of programs with an integrated intern year begin anesthesia-related orientation before the first year of clinical anesthesiology. Sixty-three percent of programs pair trainees with more than one specific individual during orientation. Programs most frequently pair trainees with anesthesiologists (75%) and/or senior residents (70%). Forty-six percent maintain this pairing for 4 weeks and 30% for 6 weeks or longer. Forty-three percent provide education on teaching practices to trainers. Introductory didactics last a median of 30 hours. Programs may blend lectures, simulations/workshops, digital content, problem-based learning, pocket references, and/or checklists into a cohesive introductory curriculum. Fifty-six percent begin call responsibilities in the sixth week of orientation or later. CONCLUSIONS: Orientation practices for clinical anesthesia training vary across residency programs in the United States. We hope this information will help program directors compare their orientation practices to other programs and identify best practices and potentially useful variations.

Assessing the differences in outcomes between general and non-general anesthesia in spine surgery: Results from a national registry.

OBJECTIVES: Endotracheal/general anesthesia is one of the most commonly used anesthetic techniques when performing thoracic and lumbar surgeries. However, spinal and epidural (non-general) anesthesia have been increasingly employed for lumbar decompressions (LD) and lumbar fusion recently. The objective of this study was to investigate the outcomes of general and non-general anesthesia in patients undergoing posterior lumbar fusion (PLF) and LD using a national registry. PATIENTS AND METHODS: ACS-NSQIP database was queried to identify patients who underwent LD or PLF with general or non-general anesthesia between 2011-2015. Patient characteristics and postoperative variables were compared. Multivariable regression was used to identify predictors of thirty-day readmission, any complication and length of stay (LOS). Three-to-one propensity-score matching and conditional logistic regression were used to adjust for potential bias. RESULTS: A total of 60,222 patients who underwent LD were identified; 59,876 (99.4%) received general anesthesia and 342 (0.6%) were given non-general anesthesia. On multivariable conditional regression, type of anesthesia was found to have no significant effect on any of the outcomes analyzed (Readmission: OR:0.90, p = 0.79; Any Complication:OR:0.75, p = 0.75; LOS:Coef.:0.18, p = 0.35). A total of 31,419 patients who underwent PLF were identified; 31,377(99.9%) were given general anesthesia and 42(0.1%) were given non-general anesthesia. Anesthesia type had no significant effect on any of the outcomes analyzed (Readmission: OR:0.78, p = 0.83;Any Complication: OR:0.50, p = 0.40; LOS: Coef.:0.17, p = 0.68). CONCLUSION: Our analysis showed that non-general anesthesia had equivalent outcomes with respect to readmission, LOS and complications compared to general anesthesia in patients undergoing LD or PLF. While the choice of anesthesia type remains a matter of preference, our results show that non-general anesthesia may be practiced safely and is associated with equivalent outcomes.

Ischemic Optic Neuropathy Following Spine Surgery: Case Control Analysis and Systematic Review of the Literature.

STUDY DESIGN: Case-control analysis and systematic literature review. OBJECTIVE: To illustrate the prognosis and perioperative risk factors associated with this condition. SUMMARY OF BACKGROUND DATA: Ischemic optic neuropathy (ION) is the most common pathological diagnosis underlying postoperative vision loss. It comes in two primary forms-anterior (AION)-affecting the optic disc or posterior (PION) affecting the optic nerve proximal to the disc. Spine surgery remains one of the largest sources of acute perioperative visual loss. METHODS: We performed a 1:4 case-control analysis (by age and year of surgery) for patients with ION and those who didn't develop ION following spine surgery at our institution. A systematic literature search of Medline, Embase, Scopus from inception to September 2017 as also performed. RESULTS: We identified 12 cases from our institution. Comparison to 48 matched controls revealed fusion, higher number of operative levels, blood loss, and change in hemoglobin, hematocrit to be significantly associated with ION. Majority were diagnosed with PION (83%, 10/12) and had bilateral presentation (75%, 9/12). Only 30% patients (3/10) demonstrated improvement in visual acuity while the rest remained either unchanged (40%, 4/10) or worsened (20%, 2/10) at last follow-up. Literature review identified 182 cases from 42 studies. Posterior ischemic optic neuropathy (PION) was found in 58.7% (114/194) of cases, anterior ischemic optic neuropathy (AION) in 17% (33/19) and unspecified ION in 24% (47/194). PION was associated with higher odds of severe visual deficit at immediate presentation (odds ratio [OR]: 6.45, confidence interval [CI]: 1.04-54.3, P = 0.04) and last follow-up. CONCLUSION: PION is the most common cause of vision loss following spine surgery and causes more severe visual deficits compared with AION. Prone spine surgery especially multi-level fusions with longer operative time, higher blood loss, and intraoperative hypotension are most associated with the development of this devastating complication. LEVEL OF EVIDENCE: 3.

The Changing Characteristics of Anesthesiology Program Directors.

BACKGROUND: Residency program directors (PD) play a critical role in graduate medical education (GME) programs. We previously published a manuscript that defined the population of programs and program directors of ACGME-accredited anesthesiology residencies and established benchmark data for comparison.1 This study compares characteristics of current anesthesiology programs and PDs with baseline data reported in our previous study. METHODS: Data were gathered through review of ACGME and American Board of Anesthesiology (ABA) websites, medical licensure records, residency program websites, and electronic search engines. Program characteristics assessed included accreditation status, number of approved positions, and previous osteopathic accreditation. PD characteristics assessed included age, academic rank, sex, time since appointment, ABA certification, and simultaneous appointment as department chair. RESULTS: The number of programs increased from 131 to 147 (12.2%) and was mostly (9/13, 68.2%) due to new ACGME-accreditation of preexisting osteopathic programs. PD age, sex, and time since appointment (3.6 years) did not differ between study periods. The number of PDs with senior academic rank and the number who also serve as department chairs decreased significantly. CONCLUSIONS: The number and size of anesthesiology programs increased since our last study. This can be largely explained by ACGME accreditation of osteopathic programs. PD characteristics are similar except for a decrease in the number with senior academic rank and the number who also serve as department chairs. There was no change in the percentage of women PDs between the study periods. The high rate of anesthesiology PD turnover and low median duration of appointment merit further investigation.

Impact of Doximity Residency Navigator on Graduate Medical Education Recruitment.

OBJECTIVE: To assess residency applicants' use and perceptions of Doximity Residency Navigator (DRN) and to analyze the impact of Doximity reputation rankings on application, interview acceptance, and match list ranking decisions. PARTICIPANTS AND METHODS: We developed and distributed a survey seeking feedback from residency applicants to describe their use of DRN during the 2017 residency recruitment and match process. The dates of the study were March 1, 2017, through May 8, 2017. RESULTS: We received responses from 2152 of 12,617 applicants (17%) across 24 graduate medical education programs. Sixty-two percent of respondents (n=1339) used DRN during the residency application, interview, and match list process. Doximity reputation rankings were noted to be valuable or very valuable to 78% of respondents (958 of 1233). Overall, 79% of respondents (977 of 1241) reported that Doximity reputation rankings influenced their application, interview acceptance, or match list ranking decisions. When asked about the accuracy of Doximity reputation rankings, 56% of respondents (699 of 1240) believed that rankings were slightly accurate or not accurate. The most commonly used resources to research potential residency programs were residency program websites, American Medical Association resources, and DRN. CONCLUSION: Most survey respondents used DRN during the application, interview, and match ranking process. Doximity reputation rankings were found to be the most valuable resource in DRN, although more than 50% of responders had doubts about the accuracy of reputation rankings.

Factors Influencing Immediate Post-Residency Career Decisions for Graduating Anesthesiology Residents.

BACKGROUND: Little is known regarding the factors that influence post-residency career decisions following anesthesiology residency training. The objective of this study was to assess the relationship between demographic and academic variables and immediate post-residency positions. METHODS: The authors conducted a retrospective review of anesthesiology resident files from 2000 to 2014 at Mayo Clinic (Rochester, MN). Univariate and multivariable analyses were used to assess relationships between demographic and academic factors and post-residency positions. RESULTS: Of the 263 anesthesiologists included, 120 (45.6%) pursued fellowship training, 110 (41.8%) entered private practice, and 33 (12.5%) entered directly into academic positions. Factors associated with career choice in univariate analyses included age, gender, country of citizenship, country of medical school, type of medical degree, and the number of peer-reviewed publications. In multivariable analyses, age, gender, and number of publications were significant predictors of post-residency career choice. Specifically, older residents were less likely to pursue fellowship training and more likely to directly enter academic positions. Males were more likely to obtain private practice positions compared to females, who were more likely to pursue advanced fellowship training. Nearly all residents entering into academic positions had at least one peer-reviewed publication. CONCLUSIONS: In this 15-year analysis of anesthesiology resident career decisions, age, gender, and number of publications were the primary predictors of career decisions. Future studies are needed to determine generalizability and to evaluate additional socioeconomic factors with the ultimate goal of optimizing residency recruitment and training initiatives in congruence with resident career interests and departmental goals.

An Early Assessment of the ACGME CLER Program: A National Survey of Designated Institutional Officials.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) is an innovative element of the ACGME's new accreditation system. To date, little information has been collected regarding the value of CLER. OBJECTIVE: The purpose of this study is to collect information on designated institutional officials' (DIOs') perspectives about the initial CLER visits conducted at their institutions. METHODS: The authors created and distributed a survey to DIOs about their initial CLER visits. Demographic data were compared across survey responses with Spearman's rank correlation and the Kruskal-Wallis test. RESULTS: The authors received responses from 63% of DIOs (186 of 297) at institutions that participated in the initial CLER visits, with 88% (164 of 186) having served as DIO during the visit. Seventy-two percent (114 of 158) reported institutional changes to address CLER focus areas prior to the visit, yet only 32% (51 of 157) reported that additional resources were allocated to these areas after the site visit. Sixty-five percent (102 of 156) reported institutional executive leadership was positive about participating in CLER; 85% (134 of 158) reported that ACGME conducted the visits efficiently; 84% (133 of 158) reported that the site visit accurately assessed the institution's performance in the CLER focus areas; and 60% (93 of 156) reported CLER provided high-value information. CONCLUSION: Survey results from DIOs suggest that CLER is an effective mechanism to improve the learning environment. Common concerns included limited advance notice for the site visit and disruptions of clinical practice.

Profound Obstructive Hypotension From Prone Positioning Documented by Transesophageal Echocardiography in a Patient With Scoliosis: A Case Report.

In a healthy 12-year-old female with scoliosis, prone positioning resulted in pressor-refractory cardiovascular collapse. Resumption of supine position immediately improved hemodynamics. Intraoperative transesophageal echocardiography (TEE) revealed a collapsed left atrium and biventricular failure. Repeat prone positioning resulted in a recurrence of hypotension. However, hemodynamic stabilization was restored and maintained by repositioning chest pads caudally. The patient successfully underwent a 6-hour scoliosis repair without perioperative morbidity. With this case, we aim to: (1) reintroduce awareness of this mechanical obstructive cause of reversible hypotension; (2) highlight the use of intraoperative TEE during prone hemodynamic collapse; and (3) suggest an alternative prone positioning technique if chest compression results in hemodynamic instability.

A peer-designed selective in anesthesiology, critical care, and perioperative medicine for first- and second-year medical students.

STUDY OBJECTIVE: The objective of this study was to design and implement a preclinical elective (termed selective) in anesthesiology, critical care, and perioperative medicine and to report survey results assessing the impact of the selective on first- and second-year medical students' understanding of basic concepts, comfort with procedural skills, and interest in the specialty. DESIGN: Preinvention and postintervention survey evaluation was used as the design of this study. SETTING: The study was conducted at Mayo Medical School and Mayo Clinic. PARTICIPANTS: The participants in this study are first- and second-year medical students. INTERVENTIONS: A 1-week introductory anesthesiology curriculum was developed to include didactic sessions, shadowing experiences, lunch and dinner panels, mentorship and networking opportunities, and procedural workshops in airway management, ultrasound, and vascular access techniques. MEASUREMENTS: Preselective and postselective surveys using a 10-point scale (1, strongly disagree; 10, strongly agree) were administered 1 week before and after the selective. MAIN RESULTS: A total of 8 students participated in the selective, with a 100% survey response rate. Students reported significant increases for all survey questions regarding basic concepts and skills. The largest increases were reported in comfort with airway management skills, understanding of the perioperative surgical home model, and vascular access skills. All participants indicated a higher likelihood of pursuing anesthesiology as a career and attributed their increased interest in anesthesiology to the selective. CONCLUSIONS: This new selective was successful in giving first- and second-year medical students a comprehensive overview of anesthesiology and increasing medical student interest in the specialty. The success of this selective leads to promising belief that similar peer-designed educational experiences can be developed at other medical schools to improve education and interest in this area of medicine.

Diversity of United States medical students by region compared to US census data.

PURPOSE: Increasing the diversity of the United States (US) physician workforce to better represent the general population has received considerable attention. The purpose of this study was to compare medical student race data to that of the US general population. We hypothesized that race demographics of medical school matriculants would reflect that of the general population. PATIENTS AND METHODS: Published race data from the United States Census Bureau (USCB) 2010 census and the 2011 Association of American Medical Colleges (AAMC) allopathic medical school application and enrollment by race and ethnicity survey were analyzed and compared. Race data of enrolled medical students was compared to race data of the general population within geographic regions and subregions. Additionally, race data of medical school applicants and matriculants were compared to race data of the overall general population. RESULTS: Race distribution within US medical schools was significantly different than race distribution for the overall, regional, and subregional populations of the US (P<0.001). Additionally, the overall race distribution of medical school applicants differed significantly to the race distribution of the general population (P<0.001). CONCLUSION: This study demonstrated that race demographics of US medical school applicants and matriculants are significantly different from that of the general population, and may be resultant of societal quandaries present early in formal education. Initiatives targeting underrepresented minorities at an early stage to enhance health care career interest and provide academic support and mentorship will be required to address the racial disparity that exists in US medical schools and ultimately the physician workforce.

The founding of the Mayo School of Graduate Medical Education.

The Mayo Foundation for Medical Education and Research (hereafter the Mayo Foundation), the precursor to the Mayo School of Graduate Medical Education, was incorporated in 1915. The Mayo Foundation, which was affiliated with the University of Minnesota Graduate School, aimed to establish a higher standard for training medical specialists. Together, the University of Minnesota and the Mayo Foundation pioneered a graduate medical education program that allowed residents to earn master's and PhD degrees in clinical medicine and surgery. Unlike elsewhere in the United States, the residency training program was not pyramidal. (In a pyramidal residency program, each training year, some residents are systematically eliminated to reduce the number of more senior trainees.) All those who started the Mayo Foundation residency program had an opportunity to finish depending on their own merits. Louis B. Wilson, the first director of the Mayo Foundation, became a major figure in graduate medical education in the 1920s and 1930s. Although the granting of graduate degrees in medicine and surgery stopped over time, Mayo Clinic ultimately became the largest site of graduate medical education in the world.

The psychological and physiological effects of acute occupational stress in new anesthesiology residents: a pilot trial.

BACKGROUND: Occupational stress in resident physicians has profound implications for wellness, professionalism, and patient care. This observational pilot trial measured psychological and physiological stress biomarkers before, during, and after the start of anesthesia residency. METHODS: Eighteen physician interns scheduled to begin anesthesia residency were recruited for evaluation at three time points: baseline (collected remotely before residency in June 2013); first-month visit 1 (July); and follow-up visit 2 (residency months 3 to 5, September-November). Validated scales were used to measure stress, anxiety, resilience, and wellness at all three time points. During visits 1 and 2, the authors measured resting heart-rate variability, responses to laboratory mental stress (hemodynamic, catecholamine, cortisol, and interleukin-6), and chronic stress indices (C-reactive protein, 24-h ambulatory heart rate and blood pressure, 24-h urinary cortisol and catecholamines, overnight heart-rate variability). RESULTS: Thirteen interns agreed to participate (72% enrollment). There were seven men and six women, aged 27 to 33 yr. The mean ± SD of all study variables are reported. CONCLUSION: The novelty of this report is the prospective design in a defined cohort of residents newly exposed to the similar occupational stress of the operating environment. Because of the paucity of literature specific to the measures and stress conditions in this investigation, no data were available to generate a priori definition of primary outcomes and a data analytic plan. These findings will allow power analysis for future design of trials examining occupational stress and stress-reducing interventions. Given the importance of physician burnout in our country, the impact of chronic stress on resident wellness requires further study.

Health literacy and anesthesia: patients' knowledge of anesthesiologist roles and information desired in the preoperative visit.

STUDY OBJECTIVE: To assess patients' knowledge of the role of the anesthesiologist and to identify information patients desire during the preoperative visit. DESIGN: Self-administered structured survey evaluation. SETTING: Preoperative Evaluation Clinic at Mayo Clinic, Rochester, Minnesota. PATIENTS: 502 adult surgical patients scheduled for elective surgery. MEASUREMENTS: A survey was designed and administered to patients in the preoperative clinic to assess their knowledge of the job descriptions and roles of anesthesiologists. The survey also included questions about information that patients desire before anesthesia and surgery. MAIN RESULTS: The survey was distributed to 502 patients, 500 of whom (99%) completed the survey. Seventy-four percent (346/466) of respondents were educated at or above the college level. The majority (377/460; 82%) of patients in this study had adequate or high health literacy levels. Four hundred sixteen of 486 (86%) respondents knew that an anesthesiologist was a doctor specializing in anesthesia. However, the roles of anesthesiologists throughout the hospital system were not well known. Ninety-six of 475 (20%) patients knew that anesthesiologists may work in pain management clinics, 80 of 470 (17%) patients knew that anesthesiologists may work in intensive care units, but only 59 of 472 (13%) patients knew that anesthesiologists may transfuse blood during surgery if needed. CONCLUSION: Despite the high level of education and health literacy in this group of patients, many were uninformed about the roles of anesthesiologists. Patients expressed interest in receiving a broad range of information during the preoperative visit. An educational booklet was the preferred method to provide this information.