Use of key words as an adjunctive learning tool improves learning during a perioperative medicine rotation for anesthesiology residents.

Designing a successful block rotation for anesthesiology residents requires not only an appropriate curriculum but also a set of teaching tools, which promote learning. Traditional clinical rotations in Anesthesiology residencies emphasize clinical teaching, supported by interaction with staff. Since Perioperative Medicine is a nontraditional subject for anesthesia residents, we introduced a syllabus and didactic curriculum to support clinical teaching. We hypothesized that the use of key words would enhance learning. Alternating groups of residents were assigned to receive key words, while control residents were expected to learn without key words. The key words were delivered in writing on the first day of the rotation and the syllabus was highlighted to identify the key words in the text. Pretests and posttests were administered to residents participating in the perioperative rotation. Learning was assessed by calculating the change in test scores. There was significantly more learning in the group given the key words. We conclude that key word designation improved learning in a rotation designed to teach perioperative medicine.

Use of Key Words as an Adjunctive Learning Tool Improves Learning During a Perioperative Medicine Rotation for Anesthesiology Residents.

Designing a successful block rotation for anesthesiology residents requires not only an appropriate curriculum but also a set of teaching tools, which promote learning. Traditional clinical rotations in Anesthesiology residencies emphasize clinical teaching, supported by interaction with staff. Since Perioperative Medicine is a non-traditional subject for anesthesia residents, we introduced a syllabus, and didactic curriculum to support clinical teaching. We hypothesized that the use of key words would enhance learning. Alternating groups of residents were assigned to receive key words, while control residents were expected to learn without key words. The key words were delivered in writing on the first day of the rotation and the syllabus was highlighted to identify the key words in the text. Pre and post-tests were administered to residents participating in the perioperative rotation. Learning was assessed by calculating the change in test scores. There was significantly more learning in the group given the key words. We conclude that key word designation improved learning in a rotation designed to teach perioperative medicine.

Consistency, inter-rater reliability, and validity of 441 consecutive mock oral examinations in anesthesiology: implications for use as a tool for assessment of residents.

BACKGROUND: Oral practice examinations (OPEs) are used extensively in many anesthesiology programs for various reasons, including assessment of clinical judgment. Yet oral examinations have been criticized for their subjectivity. The authors studied the reliability, consistency, and validity of their OPE program to determine if it was a useful assessment tool. METHODS: From 1989 through 1993, we prospectively studied 441 OPEs given to 190 residents. The examination format closely approximated that used by the American Board of Anesthesiology. Pass-fail grade and an overall numerical score were the OPE results of interest. Internal consistency and inter-rater reliability were determined using agreement measures. To assess their validity in describing competence, OPE results were correlated with in-training examination results and faculty evaluations. Furthermore, we analyzed the relationship of OPE with implicit indicators of resident preparation such as length of training. RESULTS: The internal consistency coefficient for the overall numerical score was 0.82, indicating good correlation among component scores. The interexaminer agreement was 0.68, indicating moderate or good agreement beyond that expected by chance. The actual agreement among examiners on pass-fail was 84%. Correlation of overall numerical score with in-training examination scores and faculty evaluations was moderate (r = 0.47 and 0.41, respectively; P < 0.01). OPE results were significantly (P < 0.01) associated with training duration, previous OPE experience, trainee preparedness, and trainee anxiety. CONCLUSION: Our results show the substantial internal consistency and reliability of OPE results at a single institution. The positive correlation of OPE scores with in-training examination scores, faculty evaluations, and other indicators of preparation suggest that OPEs are a reasonably valid tool for assessment of resident performance.

The effect of posture on the induction of epidural anesthesia for peripheral vascular surgery.

BACKGROUND AND OBJECTIVES: A study was done to determine whether a difference existed in the quality and time to maximum anesthesia between the induction of lumbar epidural anesthesia in the sitting and supine position in patients undergoing infrainguinal arterial reconstruction. METHODS: An epidural catheter was inserted at L3-L4 in 40 patients who were randomly assigned to two groups. In group 1, with the patient sitting, 3 mL lidocaine 1.5% with 5 micrograms/mL epinephrine was given as a test dose, followed 3 minutes later by 12 mL bupivacaine 0.75% injected over 2 minutes through the catheter. After remaining in the sitting position for 5 minutes, the patient was placed supine and the quality of anesthesia assessed at 3-minute intervals for 30 minutes. Anesthesia was assessed by loss of sensation to pinprick and the Bromage scale for loss of motor function. In group 2, after placement of the catheter, the patient was immediately placed supine, the same doses of local anesthesia were given at the same time intervals as in group 1, and the onset of anesthesia was similarly assessed. In addition to a comparison between groups in the quality and time to maximum anesthesia, a correlation was sought between these variables and the age, weight, height, and body surface area (BSA) of the patients in each group. RESULTS: The demographically similar groups showed no difference in maximum cephalad spread of anesthesia (median, interquartile range; group 1: T4, T2.5-T6; group 2: T4, T2.5-T7), motor block (group 1: 3, 2-4; group 2: 4, 4-6), or time to maximum motor block (mean +/- SD; group 1, 17.4 +/- 8.7 minutes; group 2, 17.9 +/- 6.8 minutes). The time to maximum cephalad spread of anesthesia was shorter in group 1 (13.8 +/- 6.9 minutes; group 2, 18.6 +/- 6.6 minutes; P = .03). Neither the age nor weight of the patients in either group had any influence on the quality and time to maximum anesthesia. There was, however, a significant correlation between the height (r = 0.48, P = .0303) and BSA (r = 0.48, P = .0318) of the patients in group 1 and the time to maximum cephalad spread of anesthesia. CONCLUSIONS: When lumbar epidural anesthesia was induced in the sitting rather than supine position, the time to maximum cephalad spread was shorter and correlated directly with the height and BSA of the patient. The position of the patient during induction had no effect on the final level of cephalad spread and degree of motor block.

The hemodynamic responses to an intravenous test dose in vascular surgical patients.

The study was designed to investigate the hemodynamic responses to intravenous (IV) injections of various epidural test doses in vascular surgical patients to determine whether previously established criteria in healthier populations were valid in this inherently sicker population. A double-blind, prospective randomized study was performed on 50 patients, not receiving beta-adrenergic antagonists, presenting for vascular surgery and requiring an arterial line. Patients were randomly assigned to receive a 3-mL injection of one of five solutions, either saline (Group 1), lidocaine 45 mg (Group 2), lidocaine 45 mg and epinephrine 5 micrograms (Group 3), lidocaine 45 mg and epinephrine 10 micrograms (Group 4), or lidocaine 45 mg and epinephrine 15 micrograms (Group 5). After injection, a blinded observer recorded arterial blood pressure and heart rate (HR) every 15 s for 3 min. The changes in HR, systolic (SBP), mean (MBP), and diastolic (DBP) blood pressure as well as time to maximum change were analyzed both within and between groups. Only Group 5 had significant within-group changes for all hemodynamic variables measured. Only in the comparison between Groups 1 and 5 and between Groups 2 and 5 were there significant changes in both HR and SBP. The mean increase in HR and SBP within Group 5 was 17.0 +/- 5.9 bpm and 31.0 +/- 10.5 mm Hg, respectively. No differences were found between groups for time to maximum change for HR and SBP which for Group 5 were 64.5 +/- 37.4 s and 90.0 +/- 56.7 s, respectively. To achieve 100% sensitivity and specificity for HR increase, the criterion established was > or = 9 bpm.(ABSTRACT TRUNCATED AT 250 WORDS)

Haemodynamic and metabolic consequences of aortic occlusion during abdominal aortic surgery.

We have studied the haemodynamic and metabolic effects of application and removal of the infrarenal aortic crossclamp in 20 patients during aortic reconstructive surgery for repair of aneurysmal or occlusive disease. A highly significant positive correlation was detected between the change in systemic vascular resistance (SVR) associated with application of the aortic crossclamp and the change in base deficit (BD) associated with its removal (r = 0.851; P = 0.001). There was no difference in regression analysis (P = 0.21) or mean change of SVR and BD (P = 0.73) in patients with either aneurysmal or occlusive disease. In addition, the maximum increase in mixed venous serum lactate concentration correlated positively with the duration that the aortic crossclamp was applied (r = 0.717, P = 0.0297). These observations suggest the importance of the collateral circulation in the development of metabolic acidosis during aortic surgery.