Simulation-based assessment of anesthesiology residents' competence: development and implementation of the Canadian National Anesthesiology Simulation Curriculum (CanNASC).

The specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force. The goals were to develop, implement, and evaluate a set of consensus-driven standardized mannequin-based simulation scenarios that every trainee must complete satisfactorily prior to completion of anesthesiology residency and certification. Curriculum development followed Kern's principles and was accomplished via monthly teleconferences and annual face-to-face meetings. The development and implementation processes included the following key elements: 1) Curriculum needs assessment: 368 of 958 invitees (38.4%) responded to a national survey resulting in 64 suggested scenario topics. Use of a modified Delphi technique resulted in seven important and technically feasible scenarios. 2) Scenario development: All scenarios have learning objectives from the National Curriculum for Canadian Anesthesiology Residency. Standardized scenario templates were created, and the content was refined and piloted. 3) Assessment: A validated Global Rating Scale (GRS) is the primary assessment tool, informed by using scenario-specific checklists (created via a modified Delphi technique) and the Anesthesia Non-Technical Skills GRS. 4) Implementation: Standardized implementation guidelines, pre-brief/debrief documents, and rater training videos, guide, and commentary were generated. National implementation of the scenarios and program evaluation is currently underway. It is highly feasible to achieve specialty-based consensus on the elements of a national simulation-based curriculum. Our process could be adapted by any specialty interested in implementing a simulation-based curriculum incorporating competency-based assessment on a national scale.

The effects of social context on the hormonal and behavioral responsiveness of human fathers.

We tested first-time fathers with their 22-month old toddlers to determine whether social context variables such as pre-test absence from the child and presence of the mother affected physiological measures associated with paternal responsiveness. Heart rate and blood pressure readings as well as blood samples to determine prolactin, testosterone and cortisol levels were taken before and after the 30-min father-toddler interactions. Fathers were tested on a day when they were away from their child for several hours before testing ('without-child' day) and on another day where they remained with their child throughout the day ('with-child' day). Most measures decreased over the 30-min test period but relative decreases were context-dependent. Men maintained higher prolactin levels when they were away from their children longer before testing on the 'without-child' day. Cortisol levels decreased during both tests and they decreased more on the 'with-child' day for men who had spent more time alone with their toddler before the test. Heart-rate and diastolic (but not systolic) blood pressure decreased more on the 'with-child' day than on the 'without-child' day. Fathers' testosterone levels decreased when their partners were less involved in the interactions. Compared to men with high responsiveness ratings on both days, men whose responsiveness increased after being away from their child on the 'without-child' day maintained higher systolic blood pressure and had a greater decrease in testosterone levels. We conclude that context may be more important in determining fathers' physiological responses to child contact than has previously been appreciated, particularly for some individuals.

Prolactin responses to infant cues in men and women: effects of parental experience and recent infant contact.

We used a longitudinal design to test whether parental experience differentially affects the development of prolactin responses to infant cues in men and women. Couples provided two blood samples at three tests, one test just before their babies were born, and two tests during the early postnatal period (n=21). Nine couples repeated the tests near the birth of their second babies. In the 30 min between the two samples, couples listened to recorded infant cries at the prenatal test and held their baby (fathers) or a doll (mothers) at the postnatal tests. Blood samples were analyzed for prolactin concentrations. Prolactin values were then related to sex and parity differences as well as to questionnaire data concerning emotional responses to infant cries and previous infant contact. We found that (1) prior to the birth of both the first and second babies, women's prolactin concentrations increased after exposure to infant stimuli, whereas men's prolactin concentrations decreased; postnatal sex differences varied with parity; (2) women's prolactin reactivity did not change significantly with parental experience; (3) the same men's prolactin concentrations decreased after holding their first newborns but increased after holding their second newborns; this change was not gradual or permanent; (4) men reporting concern after hearing recorded infant cries showed a different postnatal pattern of prolactin change after holding their babies than men not reporting concern; and (5) men who had little contact with their babies just prior to testing had a more positive prolactin response than men who had recently held their babies for longer periods. Although parental experience appears to affect men's prolactin responses, differences in reactivity were also related to patterns of recent infant contact and individual differences in responses to infant cues.