Drivers of Well-Being and Burnout in Anesthesiology Residents.

Background: With more than 50% of anesthesiology residents reporting burnout, many residency programs have begun creating wellness programs to address burnout and promote well-being. However, to date, many wellness initiatives have focused on individual strategies rather than systems approaches to improve the learning environment. Individual-focused interventions in the absence of systematic efforts can lead to resentment, resistance, and worsening burnout and precipitate a loss of trust in leadership and the organization. Here, we describe a process to engage anesthesiology residents, who are key stakeholders, by exploring their perspectives on burnout and well-being to better inform systematic interventions to improve the clinical work and learning environments. Methods: We conducted semistructured interviews with second- and third-year clinical anesthesia residents at the University of California, San Francisco, using the areas of worklife model as sensitizing concepts. We conducted a thematic analysis on transcribed interviews grounded in constructivist orientation. Results: We identified the following 3 major categories of themes based on interviews with 10 residents: (1) definition of well-being, (2) challenges to well-being, and (3) strategies for coping with challenges and burnout. Challenges described by anesthesiology residents align with the areas of the worklife model, with the coronavirus disease 2019 pandemic precipitating additional threats in the domains of workload and community. Conclusions: Anesthesiology residents' definition of well-being includes both individual (resilience) and systemic (meaning in work, job autonomy, and control) factors, reaffirming that positive work and learning environments are critical to professional well-being.

Conflict Management Education for Anesthesiology Residents: Bridging the Gap in Interpersonal and Communication Skills Competency.

Effective communication and conflict management are important skills for anesthesiologists and are designated by the Accreditation Council for Graduate Medical Education (ACGME) as elements of the "interpersonal and communication skill" competency (ACGME Anesthesiology Milestone Project 2020). However, structured conflict management education for anesthesiology residents remains limited. To address this gap, we developed and implemented a conflict management session incorporating didactics and application exercises using role-play and high-fidelity simulation (SIM) for anesthesiology residents (postgraduate years 3 and 4) at a tertiary academic medical institution. These sessions were well-received, and both role-play and SIM appear to help residents learn conflict management skills.

Design and Implementation of an Innovative, Longitudinal Wellness Curriculum in an Anesthesiology Residency Program.

Burnout is a serious problem that anesthesiologists face during training and in practice. To mitigate it, experts advocate for strategies focused on enhancing individual resilience in addition to organizational change in health care systems. To catalyze this change, wellness-focused education must incorporate foundational knowledge about the science of well-being and impart skills to empower trainees to lead change in the future. We developed and implemented a longitudinal, developmental 3-year curriculum in a large anesthesiology residency program that included strategies to strengthen community-building, enhance meaning from a career in medicine, and incorporated topics focused on career and leadership development.

Innovations in anaesthesia medical student clerkships.

Undergraduate medical education is currently being reformed to adapt to our evolving systems of health care. Medical student curricula are focussing less on mastery of knowledge and clinical skills and more on achieving multiple competencies that will provide students with a solid foundation to practice in complex health-care environments. Anaesthesiologists are uniquely positioned to teach towards a number of competencies. In order to do so, innovations in the traditional apprentice-style clerkships need to be considered. Anaesthesiology rotations should be made part of the core curriculum in order to meet evolving student educational needs and better position anaesthesia educators to assist future curriculum reform. Innovative approaches applicable to anaesthesia clerkships include the use of integration techniques, continuity of patient care and educator preceptorship, as well as multidisciplinary and interprofessional teaching. Continued inquiry into teaching effectiveness and curricular innovation is critical in order to meet the educational needs of future medical students.

Special article: rescue therapies for acute hypoxemic respiratory failure.

The recent H1N1 epidemic has resulted in a large number of deaths, primarily from acute hypoxemic respiratory failure. We reviewed the current strategies to rescue patients with severe hypoxemia. Included in these strategies are high-frequency oscillatory ventilation, airway pressure release ventilation, inhaled vasodilators, and the use of extracorporeal life support. All of these strategies are targeted at improving oxygenation, but improved oxygenation alone has yet to be demonstrated to correlate with improved survival. The risks and benefits of these strategies, including cost-effectiveness data, are discussed.