Analysis of teaching methods in anaesthesia in the undergraduate curriculum of four veterinary universities.

OBJECTIVE: To design a holistic audit tool to assess the effectiveness of anaesthesia teaching strategies, and thereby to study veterinary undergraduate teaching methods in different geographical areas. STUDY DESIGN: Qualitative study using interviews of university staff and students to identify common themes and differences in teaching veterinary anaesthesia. METHODS: An audit was performed using an audit tool in four veterinary universities (École Nationale Vétérinaire d'Alfort, France; Royal Veterinary College, UK; University of Buenos Aires, Argentina; and Alma mater studiorum - Università di Bologna, Italy). First, an open-question interview of anaesthesia head of service (60-90 minutes) identified the pedagogical strategies in order to conceive a subsequent semi-directive interview formulated as a SWOT analysis (Strength/Weaknesses/Opportunity/Threats). Second, the SWOT reflection was conducted by a second staff member and focussed on: 1) general organization; 2) topics for pre-rotation teaching; 3) teaching methods for clinical rotation; and 4) assessment methods. Qualitative analysis of the interview responses was performed with semi-structured interviews. Finally, the students evaluated their teaching through a students' questionnaire generated from the output of both interviews. RESULTS: A group of nine lecturers and 106 students participated in the study at four different sites. Preclinical teaching ranged from 13 to 24 hours (median 15 hours). Clinical teaching ranged from 4 to 80 hours (median 60 hours). Overall, all faculties perceived time as a limitation and attempted to design strategies to achieve the curriculum expectations and optimize teaching using more time-efficient exercises. Large animal anaesthesia teaching was found to be a common area of weakness. Internal feedback was delivered to each university, whereas generalized results were shared globally. CONCLUSIONS: This preliminary study proved the generalizability of the protocol used. Recruiting a larger pool of universities would help to identify and promote efficient teaching strategies and innovations for training competent new graduates in an ever-expanding curriculum.

Tooth injury in anaesthesiology / Lesão dentária na anestesiologia

BACKGROUND AND OBJECTIVES: Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS: In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS: Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.

JUSTIFICATIVA E OBJETIVOS: A lesão dentária é a complicação mais comum da anestesia geral e apresenta importantes consequências físicas, econômicas e médico-legais. O objetivo deste estudo é fazer uma revisão sobre as características da lesão dentária associada a anestesiologia e os métodos de prevenção existentes. CONTEÚDO: Nesta revisão são abordados o momento da anestesia em que a lesão dentária ocorre, os dentes acometidos, o tipo de lesão mais frequente, os fatores de risco estabelecidos, as estratégias de prevenção, os dispositivos de proteção e as implicações médico-legais inerentes à sua ocorrência. CONCLUSÕES: Antes de iniciar qualquer procedimento médico que exija o recurso à laringoscopia clássica é imperativa uma avaliação pré-anestésica minuciosa e detalhada do estado dentário do doente, de forma a identificar os dentes em risco, analisar a presença de fatores associados a dificuldades de intubação e delinear uma estratégia de prevenção que seja adaptada ao risco de lesão dentária de cada doente.

Work-related mental and behaviour disorders in anesthesiologists / Transtornos mentais e do comportamento relacionados ao trabalho em médicos anestesiologistas

BACKGROUND: Anaesthesiology is a specialty whose specificity of the working process results in high levels of stress as an inevitable condition - a particularly worrying situation in the daily life of these professionals. OBJECTIVES: This study, based on data from national and international literature, aims to discuss the basis of the occurrence of mental and behavioural disorders or of psychopathological injuries (psychological distress) related to working activity in anesthesiologists. METHOD: A literature review was conducted, with papers selected from Medline and Lilacs databases, published between 2000 and 2012 in Portuguese, English and Spanish, and addressing the possible association between occupational hazards of the anaesthesiologist profession and mental health problems and psychic distress. Twenty-six publications were listed. RESULTS: Several aspects of the anesthesiologist's work are important points to better understand the relationship between mental health at work and working organization. Poor temporal structuring of work, conflictuous interpersonal relationships and poor control over the activity itself may be mentioned as illness enhancers. CONCLUSION: The working organization, when not appropriate, is an important occupational risk factor for the life and mental health of workers, mainly of professionals focused on the care of people. This paper focuses on anesthesiologists, who are constantly exposed to stressful and anxiogenic factors.

JUSTIFICATIVA: a anestesiologia é uma especialidade cuja especificidade do processo de trabalho torna elevados níveis de estresse uma condição inevitável, situação preocupante no cotidiano desses profissionais. OBJETIVOS: o presente estudo, fundamentado em dados da literatura nacional e internacional, tem o propósito de discutir as bases da ocorrência de transtornos mentais e de comportamento ou agravos psicopatológicos (sofrimento psíquico) relacionados à atividade laboral em médicos anestesiologistas. MÉTODO: fez-se uma revisão de literatura em que foram selecionados artigos científicos nas bases de dados Medline e Lilacs, publicados entre 2000 e 2012, em português, inglês e espanhol, que abordam a possível associação entre riscos ocupacionais da profissão de médico anestesiologista e problemas de saúde mental e sofrimento psíquico. Foram enumeradas 26 publicações. RESULTADOS: vários aspectos do trabalho do médico anestesiologista apresentam-se como pontos importantes para a compreensão das relações entre saúde mental no trabalho e organização do trabalho. Podem ser destacados como adoecedores a má estruturação temporal do trabalho, as relações interpessoais conflituosas e o mau controle sobre a própria atividade. CONCLUSÃO: a organização do trabalho, quando não adequada, é um importante fator de risco ocupacional para a vida e a saúde mental dos trabalhadores, principalmente, dos profissionais voltados para o cuidado de pessoas. O foco presente são os médicos anestesiologistas, constantemente expostos a fatores estressantes e ansiogênicos.

[Work-related mental and behaviour disorders in anesthesiologists]. / Transtornos mentais e do comportamento relacionados ao trabalho em médicos anestesiologistas.

BACKGROUND: Anaesthesiology is a specialty whose specificity of the working process results in high levels of stress as an inevitable condition - a particularly worrying situation in the daily life of these professionals. OBJECTIVES: This study, based on data from national and international literature, aims to discuss the basis of the occurrence of mental and behavioural disorders or of psychopathological injuries (psychological distress) related to working activity in anesthesiologists. METHOD: A literature review was conducted, with papers selected from Medline and Lilacs databases, published between 2000 and 2012 in Portuguese, English and Spanish, and addressing the possible association between occupational hazards of the anaesthesiologist profession and mental health problems and psychic distress. Twenty-six publications were listed. RESULTS: Several aspects of the anesthesiologist's work are important points to better understand the relationship between mental health at work and working organization. Poor temporal structuring of work, conflictuous interpersonal relationships and poor control over the activity itself may be mentioned as illness enhancers. CONCLUSION: The working organization, when not appropriate, is an important occupational risk factor for the life and mental health of workers, mainly of professionals focused on the care of people. This paper focuses on anesthesiologists, who are constantly exposed to stressful and anxiogenic factors.

Work-related mental and behaviour disorders in anesthesiologists.

BACKGROUND: Anaesthesiology is a specialty whose specificity of the working process results in high levels of stress as an inevitable condition - a particularly worrying situation in the daily life of these professionals. OBJECTIVES: This study, based on data from national and international literature, aims to discuss the basis of the occurrence of mental and behavioural disorders or of psychopathological injuries (psychological distress) related to working activity in anesthesiologists. METHOD: A literature review was conducted, with papers selected from Medline and Lilacs databases, published between 2000 and 2012 in Portuguese, English and Spanish, and addressing the possible association between occupational hazards of the anaesthesiologist profession and mental health problems and psychic distress. Twenty-six publications were listed. RESULTS: Several aspects of the anesthesiologist's work are important points to better understand the relationship between mental health at work and working organization. Poor temporal structuring of work, conflictuous interpersonal relationships and poor control over the activity itself may be mentioned as illness enhancers. CONCLUSION: The working organization, when not appropriate, is an important occupational risk factor for the life and mental health of workers, mainly of professionals focused on the care of people. This paper focuses on anesthesiologists, who are constantly exposed to stressful and anxiogenic factors.

Tooth injury in anaesthesiology.

BACKGROUND AND OBJECTIVES: Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS: In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS: Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.

[Tooth injury in anaesthesiology]. / Lesão dentária na anestesiologia.

BACKGROUND AND OBJECTIVES: Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS: In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS: Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.

La calidad en la formación de los recursos humanos en anestesiología y reanimación / Quality in the formation of human resources in Anaesthesiology and Reanimation

Introducción: la calidad es un concepto extraído de la industria y aplicado a la medicina, que ha evolucionado constantemente durante los últimos años. Objetivo: Identificar el nivel de la calidad en la formación de recursos humanos en la especialidad de Anestesiología y Reanimación. Métodos: Con fecha 2 de mayo y hasta el 2 de junio del 2012 se circuló por la lista de Anestesiología una encuesta que sirviera para identificar el estado actual de la calidad de la formación de los recursos humanos en Anestesiología y Reanimación. Se realizó de forma anónima, por medio de preguntas de fácil respuesta dirigidas a residentes de tercero y cuarto año. Resultados: La mayoría de los encuestados (90 %) señalaron que se cumplieron las expectativas en su formación académica como anestesiólogos y que esta estuvo acorde con el nivel científico de sus profesores. Asimismo manifestaron que la calidad de la educación influyó en el trabajo y calificaron su formación de excelente y buena. Otros (10 %) señalaron que las pirámides docentes están incompletas, que no hay nuevas tecnologías para aplicar en la especialidad y calificaron su formación como regular. Conclusiones: Independientemente de los resultados obtenidos en el estudio, los profesores de mayor nivel académico deben trabajar con más exigencia. Se sugiere aplicar un sistema de gestión de la calidad que cumpla con los requisitos establecidos por las Normas ISO 9000:2000, que evalúe de forma frecuente y mantenida la calidad de la formación de recursos humanos.

Background: quality is a concept that has been drawn from industry and applied to Medicine. This concept has evolved in recent years. Objectives: To identify the quality of life in the formation of human resources in the specialty of Anaesthesiology and Reanimation. Methods: from May, 2 to June 2, an inquiry was done by the Anaesthesiology Department in order to identify the current state of quality in the formation of human resources in Anaesthesiology and Reanimation. This survey was carried out anonymously by asking easy questions to the 3rd and 4th year residents. Results:The majority of the respondents (90%) pointed out that their expectations for their academic formation as Anaesthesiologists were fulfilled which was in agreement with the scientific level of their professors. Similarly, they stated that the quality of education influenced in their work and marked their formation as excellent and good. Other respondents (10%) pointed out that the teaching pyramids are incomplete, that there are no new technologies to apply in the specialty and qualified it as regular. Conclusions:It is concluded that, regardless of the results obtained in the study, the professors with the highest academic levels should be more demanding. The implementation of a quality management system that responds to the requirements established by the ISO norms 9000:2000 and evaluates the quality of the formation of human resources in a systematic and maintained form is also suggested.

Conocimiento del desfibrilador automático externo (DEA) por parte de candidatos a instructores en reanimación básica / Trainee basic reanimation instructors' knowledge concerning an automated external defibrillator (DEA)

Antecedentes. El uso apropiado del desfibrilador automático externo (DEA) hace parte del tercer eslabón de la cadena de supervivencia, fundamental para el manejo del paro cardiaco más frecuente en el adulto, la Fibrilación Ventricular (FV). La capacitación en las maniobras básicas de reanimación tiene 3 estaciones de trabajo: la RCP o maniobras de compresiones y ventilaciones, el manejo de la obstrucción de la vía aérea y el manejo del DEA. Objetivo. Evaluar el conocimiento previo que tienen sobre el DEA, los aspirantes a instructores en Reanimación Cardiocerebropulmonar (RCCP) Básico. Material y Métodos. Estudio de corte transversal descriptivo, en asistentes al taller de formación de instructores en RCCP Básico (n=4 residentes de anestesiología y 29 anestesiólogos), durante el Congreso Peruano de Anestesiología (octubre de 2012). En la estación de manejo del DEA se realizó un taller de formación de instructores en RCCP Básico a 4 residentes de anestesiología y 29 anestesiólogos. En la estación del manejo del DEA se realizó una encuesta a partir de 3 interrogantes básicos: ¿para qué sirve?, los factores que interfieren en su funcionamiento y las indicaciones. Resultados. Los 33 asistentes respondieron la encuesta. 17 participantes, respondieron correctamente la primera pregunta. En la segunda pregunta, 14 participantes no propusieron ningún factor; 11 acertaron con un solo factor, 3 con 2 factores y 5 con 3 factores. En la tercera pregunta, 14 contestaron correctamente. Conclusión. Este estudio encontró un desconocimiento al ingreso al taller, de los principios básicos del DEA. Se sugiere continuar con los lineamientos básicos de enseñanza en el manejo del DEA y de renovar la adquisición de estas competencias en un periodo no mayor de 2 años.

Background. The proper use of an automated external defibrillator (AED) forms part of the third link in the chain of survival; it is fundamental in managing ventricular fibrillation (VF the most commonly occurring cardiac arrest in adults). Training in basic resuscitation manoeuvres consists of 3 workstations: cardiopulmonary resuscitation (CPR) or compression and ventilation manoeuvres, airway obstruction management and AED management. Objective. Assessing basic cardiocerebral pulmonary resuscitation (CCPR) trainee instructors' prior knowledge concerning AED. Methods. This was a descriptive crosssectional study regarding trainees attending a basic CCPR workshop which was run by the AED management station during the Peruvian Anaesthesiology Congress held in October 2012 (n = 4 anaesthesiology residents and 29 anaesthesiologists). Three basic questions were asked in a survey of those attending the AED management station: "What is its purpose?", "Which factors interfere with its operation?" and "What are the pertinent indications?" Results. Seventeen of the 33 participants answering the survey answered the first question correctly. Fourteen participants did not propose any factor at all in response to the second question, eleven stated a single factor, three stated 2 factors and five 3 factors. Fourteen answered the third question correctly. Conclusion. The study revealed a lack of knowledge regarding the basic principles of AED on admission to the workshop. It is thus suggested that efforts be made to continue teaching basic guidelines regarding how to manage AED and that acquiring these skills should be renewed in a period not exceeding two years.

Boletim eletrônico de anestesia: a anestesiologia na era digital / Electronic report of anesthesia: the anaesthesiology in the digital age

A sociedade, assim como a Medicina, esteve, nas últimas décadas, questionando condutas e priorizando ações que melhor se adaptassem ao conceito de ser ecologicamente correto. Com isso, renderam-se às facilidades do mundo digital, trazendo à rotina hospitalar, entre tantas outras novidades, prontuários e boletins eletrônicos. O boletim de anestesia é um dos instrumentos de trabalho do anestesiologista, sendo um documento de relevante importância por conter todas as informações relativas ao paciente e acontecimentos ocorridos na sala cirúrgica. Seu uso está fortemente vinculado à defesa do profissional em casos jurídicos, à avaliação das técnicas anestésicas utilizadas, às pesquisas epidemiológicas e ao ensino e aprendizagem de médicos especializados. Atingir a meta de uma documentação clara e completa em cada boletim de anestesia é um desafio, especialmente em situações em que o anestesiologista é responsável pelo cuidado de múltiplos pacientes e seu foco primário de atenção está no cuidado ao paciente e no ensino a médicos especializandos. Frente a esta realidade, a era digital na anestesiologia tem apresentado promissoras soluções...

The society, as well as medicine, has been challenging behaviors and prioritizing actions that would be better adapted to the concept of being environmentally friendly in recent decades, with facilities that haue surrendered to the digital world, bringing to the hospital routine, among many other innovations, electronic records and newsletters. The report of anesthesia is one of the working tools of the anesthesiologist and a document of great significance because it contains ali information relating to patients and events in the operating room. Its use is strongly linked to the defense of professional legal cases, evaluation of anesthetic techniques used, the epidemiological research and teaching and learning of medical trainees. Achieving the goal of a complete and clear documentation of anesthesia in each report is a challenge, especially in situations where the anesthesiologist is responsible for the care of multiple patients and their primary focus of attention is on patient care and education for medical trainees. Faced with this reality, the digital age has made anesthesia promising solutions...

Auditoria média en anestesia / Audit medicates in anestesiology

Debido a la difusión de los derechos de los pacientes, el profesional médico se ve afectado por denuncias públicas. Esto lleva al desarrollo de Programas de Auditoria Médica que tiene por objeto la evaluación periódica de la calidad de atención médica a través del expediente clínico. La Auditoria Médica es un mecanismo de perfeccionamiento y educación médica continua, basada en la utilización de normas, protocolos y registros, aplicando acciones correctivas y preventivas, permitiendo tomar resguardo en aspectos técnicos, administrativos, éticos y principalmente médico legales. Engloba aspectos educativos, de control, normativos, investigativos, médico legales, evaluativos, sistemáticos, multidisciplinarios, la gestión de calidad y los aspectos financieros. La Auditoria Médica evalúa el acto médico del anestesiólogo a través de la evaluación de: la visita preanestésica, del manejo transoperatorio, la posanestesia y el alta de recuperación, los acontecimientos adversos y el registro anestésico. Por tanto la responsabilidad del médico anestesiólogo es cada vez mayor y la Auditoria Médica esté dirigida a prevenir el error médico y contribuye a elevar la calidad asistencial en los hospitales.

Due to the diffusion of the rights of the patients, the medical professional meets affected by public denunciations. This leads to the development of Programs of Medical Audit that takes as an object the periodic evaluation of the quality of medical attention across the clinical process. The Medical Audit is a mechanism of development and medical constant education, based on the utilization of procedure, protocols and records, applying corrective and preventive actions(shares), allowing to take security in technical, administrative, ethical aspects and principally medically legal. Doctor includes educational aspects, of control, normative, investigative, legal, evaluative, systematic, multidisciplinary, the management of quality and the financial aspects. The Medical Audit evaluates the medical act of the anesthesiologist across the evaluation of: the visit preanestésic, of the managing transoperatory, the posanestesic and the discharge of recovery, the adverse events and the anesthesic record. Therefore the responsibility of the doctor anesthesiologist is every time major and the Medical Audit is directed to anticipate the medical mistake and helps to raise the welfare quality in the hospitals.