Theme Issue EditorialRole of simulators, educational programs, and nontechnical skills in anesthesia resident selection, education, and competency assessment☆
Introduction
Many in health care education acknowledge that changes are needed in medical training. Specifically, the goals of medical education must be more closely linked to skills in patient management and increased patient safety [1], [2]. There are many similarities between anesthesia and aviation for handling critical situations that may be examined when determining how to go about making these changes [3], [4], [5]. Current anesthesia residency training in the United States combines practice in the operating room and didactic learning for a 3-year period, with anesthesia residents progressively given increasing independence as they gain knowledge and experience. Too much independence too soon is a threat to patient safety. Many anesthesia programs incorporate time in the anesthesia simulator during the first months of the clinical anesthesia year 1 (CA-1) as a way to monitor, evaluate, and educate new residents as they transition from internship to the practice of clinical anesthesia. Appropriate direction during this period is essential to patient safety [6], [7], [8], [9].
Certified registered nurse anesthetists (CRNAs) in academic programs help to optimize work hours and educational experiences for residents. At the present time, an attending anesthesiologist may concurrently direct patient care provided by multiple residents or CRNAs. With a 1:2 staffing ratio (1 attending anesthesiologist concurrently directing 2 operating rooms if a resident is involved), the anesthesia service balances supervision with the experience of involved residents and case complexity to optimize teaching effectiveness and patient safety. For example, after the first 1 to 2 months of the academic year, an attending anesthesiologist directing a CA-1 resident may be concurrently assigned a more experienced resident or CRNA rather than concurrent direction of 2 CA-1 residents. This allows the attending physician to spend more time in the operating room with the less experienced resident while concurrently directing patient care by the more experienced resident or CRNA.
Early in the academic year also, beginning anesthesia residents are often taking extensive simulator classes to improve basic manual and clinical skills. Appropriate supervision, simulator sessions, and working with more experienced anesthesia residents are important teaching methods during the CA-1 year. Learning the nontechnical skills should formally begin with these simulator sessions.
Section snippets
Selection of residents in the anesthesia programs
Residents are typically selected for an anesthesiology residency program according to local practices. Factors considered include academic credentials, preparedness, ability, aptitude, letters of reference, communication skills, and personal qualities such as motivation and integrity [10], [11], [12], [13], [14]. Applicants for all programs must have passed at least part 1 of the USMLE before initial application. Successful applicants to most programs must also pass USMLE part 2 before
Discussion
The role of simulators for training CA-1 residents is invaluable [5], [34], [35], [36], [39], [40], [57]. Intubation skills, fiberoptic intubation, and starting intravenous lines—all of these manual procedures are developed much faster and with higher success rates when simulators are used. The next evolutionary step will be creating more teaching programs using simulators to teach residents how to approach different critical situations (Fig. 1).
In our program, a new residency review
Conclusion
Training of anesthesia residents is evolving and higher standards in this field should produce safer anesthesia providers. The role of teaching and evaluating programs with special emphasis on nontechnical skills is at the forefront of evaluation and evaluation-evolution.
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The preparation of this manuscript was supported by the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL.