Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists

Purpose

Point-of-care ultrasound (POCUS) involves the bedside use of ultrasound to answer specific diagnostic questions and to assess real-time physiologic responses to treatment. Although POCUS has become a well-established resource for emergency and critical care physicians, anesthesiologists are still working to obtain POCUS skills and to incorporate them into routine practice. This review defines the benefits of POCUS to anesthesia practice, identifies challenges to establishing POCUS in routine anesthesia care, and offers solutions to help guide its incorporation going forward.

Principal findings

Benefits to POCUS include improving the sensitivity and specificity of the physical examination and helping to guide patient treatment. The challenges to establishing POCUS as a standard in anesthesia practice include developing and maintaining competence. There is a need to develop standards of practice and a common language between specialties to facilitate training and create guidelines regarding patient management.

Conclusions

Presently, our specialty requires consensus by expert stakeholders to address issues of competence, certification, development of standards and terminology, and the management of unexpected diagnoses. To promote POCUS competency in our discipline, we support its incorporation into anesthesiology curricula and training programs and the continuing professional development of POCUS-related activities at a national level.

     

Mentorship in anesthesia: a survey of perspectives among Canadian anesthesia residents

Purpose

Mentorship is important for professional and academic growth; however, the role of mentorship in anesthesia is still being defined. We surveyed Canadian anesthesia residents to explore their perceptions of mentorship relationships.

Methods

We administered a 20-item cross-sectional survey to program directors and anesthesia residents in all Canadian departments of anesthesia. Program directors were asked about their mentorship programs, and residents were asked about their perceptions of benefits and barriers to effective mentoring.

Results

Sixteen of 17 (94%) program directors and 189 of 585 (32%) anesthesia residents responded to our survey. While 143 of 180 (79%) residents agreed that mentorship was beneficial to overall success as an anesthesiologist, only 11 of 16 (69%) program directors reported formal mentorship as part of their residency program, and only 119 of 189 (63%) residents reported access to a mentor. Barriers reported by residents included insufficient time with mentors, lack of formalized meeting times and objectives, mentor-mentee incompatibility (personal or professional), and lack of resident choice in mentor selection.

Conclusion

Our study confirms that, despite positive perceptions among residents, mentorship remains underutilized in anesthesia programs. We identify barriers to effective mentorship, including the need to consider resident choice as a means to improve formal anesthesia mentorship programs.

     

Fringe Benefits Among US Orthopedic Residency Programs Vary Considerably: a National Survey

Background

Residency programs compete to attract applicants based on numerous factors. Previous research has suggested that medical students consider quality of life among the most important factors in selecting a program. One aspect of workplace quality of life is the cadre of non-monetary benefits offered to employees. However, with federal funding for graduate medical education (GME) under consideration for spending cuts, the source and continuation of such benefits may be in question.

Questions/Purposes

This study aimed to determine the level and variability of benefits beyond standard salary and insurance options available to trainees at US orthopedic residency programs and to assess the source of funding for those benefits.

Methods

A 26-question survey investigating various benefits and funding sources was circulated by email to all ACGME-accredited orthopedic residency programs.

Results

The survey was sent to 153 programs and 69 responded (45%). The majority offers their residents discretionary funds (77%) and conference funding (96%), most of which comes from the department, followed by the hospital or GME funding. Forty-one percent of respondents permit their residents to moonlight. The majority of respondents provide meal stipends (93%), free parking (71%), gym benefits (63%), surgical loupes (53%), and maternity/paternity leave beyond vacation time (55%). No statistically significant differences were found among top ranked residencies, top ranked orthopedic hospitals, or academic centers compared to their counterparts.

Conclusion

While some benefits are commonly offered, there is great variation in the availability and level of others. However, these differences were independent of program and hospital reputation as well as academic center status. Departments currently bear a substantial amount of the cost of these benefits internally.

     

Versorgung von Notfallpatienten in Bedrohungslagen

Background

The increasing threat of terrorist attacks necessitates adaption of preclinical emergency medicine.

Objective

Presentation of international lessons learned, the current approach of the military and police and deductions for the German authorities and organizations.

Material and methods

Review of the currently available literature and comparison with the author’s experience in tactical medicine.

Results

Guidelines for tactical combat casualty care (TCCC) provide a powerful tool that reduces the risk for responders and casualties and increases the probability of survival by directing the provider towards diagnosis and treatment of the most relevant injury patterns.

Conclusion

The principles of military guidelines are also applicable and successful in civil terrorist scenarios. The key to success is not only the training of medical personnel in these guidelines but also appropriate training and equipment for police forces.

     

Perception and Awareness of Bariatric Surgery in Canada: a National Survey of General Surgeons

Background

The objective of this study was to assess Canadian general surgeons’ knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients.

Methods

A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012. The survey was also disseminated via membership association electronic newsletters in November and December 2012.

Results

One hundred sixty-seven questionnaires were completed (104 practicing surgeons, 63 general surgery trainees). Twenty respondents were bariatric surgeons. Among 84 non-bariatric surgeons, 68.3 % referred a patient in the last year for bariatric surgery, 79 % agreed that bariatric surgery resulted in sustained weight loss, and 81.7 % would consider referring a family member. Knowledge gaps were identified in estimates of mortality and morbidity associated with bariatric procedures. The majority of surgeons surveyed have encountered patients with complications from bariatric surgery in the last year. Over 50 % of surgeons who do not perform bariatric procedures reported not feeling confident to manage complications, 35.4 % reported having adequate resources and equipment to manage morbidly obese patients, and few are able to transfer patients to a bariatric center. Of the respondents, 73.3 % reported residency training provided inadequate exposure to bariatric surgery, and 85.3 % felt that additional continuing medical education resources would be useful.

Conclusions

There appears to be support for bariatric surgery among Canadian general surgeons participating in this survey. Knowledge gaps identified indicate the need for more education and resources to support general surgeons managing bariatric surgical patients.

     

Überlegungen zur künftigen Ausbildung und Bestellung von Leitenden Notärzten

Background

Given the current and future security situation, it appears necessary to reform the training and appointment of senior emergency physicians and to harmonize these nationwide. The goal of the authors is to describe the current situation, identify needs for action and possible solutions, and thus to encourage discussions in authoritative bodies.

Methods

Presentation of the current training and appointment practice, using the current situation in Bavaria as an example.

Results

The aim is to establish a uniform and updated training of future senior emergency physicians, so that they can more efficiently fulfill future positions.

Discussion

The current training of senior emergency physicians needs urgent revision with regard to general security policy development and the integrated security of the German authorities.

     

Qualitätssicherung in Laser- und Plasmamedizin

Background

Maxillofacial surgery is constantly developing and introducing new medical technology, such as laser and plasma devices.

Objective

Process-oriented quality management by continuing postgraduate education in new technological procedures.

Material and methods

Compilation of essential guidelines and quality-oriented educational programs in laser and plasma medicine.

Results

The university based continuing education for a diploma in aesthetic laser medicine (DALM) is a postgraduate study program accredited in 1999 by the state authorities and based on an interdisciplinary, multicenter, industry-independent and scientific curriculum that leads to board certification.

Conclusion

The DALM program is an important instrument for process-oriented quality management in plasma and aesthetic laser medicine.

     

Patellaformen

Background

Patella height is discussed as a possible factor in the development of osteoarthritis of the knee.

Methods

PubMed literature search

Results

Contradictory results are found in the literature.

Conclusion

According to the literature, there is currently no evidence that abnormal patella height can induce osteoarthritis of the knee.

     

Systematic review on the effectiveness of augmented reality applications in medical training

Background

Computer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training.

Methods

PubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated.

Results

Twenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use.

Conclusion

Augmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.

     

Einmal Notarzt – immer Notarzt?

Background

Prehospital emergency care aims at providing the best possible care to the emergency patient. In the German two-tier ambulance service both emergency physicians and paramedics are deployed. Besides initial training, continuous medical education is significant for preservation of competency.

Methods

Review of the current literature.

Results

Regulation of qualification and continuing education of emergency physicians is heterogeneous in Germany. Some state laws and associations of emergency physicians recognize the need for continuous training and call for regular and emergency-specific training. However, uniform requirements are needed.

     

Female Pelvic Medicine and Reconstructive Surgery—What Does Certification Mean?

Purpose of Review

There are advantages and disadvantages of subspecialty certification for physicians, trainees, patients, and society at large. As female pelvic medicine and reconstructive surgery (FPMRS) became the second subspecialty of urology to offer subspecialty certification, understanding the effects of FPMRS subspecialty certification on the healthcare system is important.

Recent Findings

While subspecialty certification may improve training, identify experts, and ultimately lead to improved patient outcomes, certification might also be unnecessary for some physicians, weaken residency training, and limit the number of physicians who are deemed qualified to offer certain treatments. As pelvic floor disorders can considerably affect quality of life, and their prevalence is expected to increase with the aging population, high-quality FPMRS care is needed. In this article, we describe the history of FPMRS subspecialty certification as well as its potential advantages and disadvantages as suggested by literature.

Summary

There are advantages and disadvantages of FPMRS subspecialty certification. Further research is needed to assess the effect of FPMRS subspecialty certification on patient outcomes.

     

Task Shifting: The Use of Laypersons for Acquisition of Vital Signs Data for Clinical Decision Making in the Emergency Room Following Traumatic Injury

Importance

In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care.

Objective

To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients.

Design

We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention.

Setting

The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi.

Participants

All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014).

Intervention

Lay people were trained to take and record vital signs.

Main outcomes and measures

The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis.

Results

Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded.

Conclusions and relevance

The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.

     

Entzündlich-rheumatische Erkrankungen

Background

Inflammatory rheumatic diseases can lead to cartilage changes.

Methods

PubMed literature search

Results

The rheumatoid arthritis can produce degrading enzymes and cause cartilage damage; longitudinal studies do not exist.

Conclusion

There are no high level studies. The expert opinion is that infammatory rheumatic diseases can lead to osteoarthritis of the knee.

     

Komplikationsmanagement im Internet Marketing

Background

New patients come more and more often over the internet; therefore internet marketing plays an increasingly important role.

Question

How can physicians build an effective internet marketing strategy and avoid complications?

Method

Selection and authorization of a reputable agency.

Results

New customer acquisition through high visibility in the internet, at the same time increasing the image and awareness.

Conclusions

In the overall “marketing mix” internet marketing has become indispensable to physicians who want to be successful. Those who are well positioned in Google are well known by their target audience and thus receive a higher response.

     

Beinachsen- und Fußfehlstellung

Background

Varus and valgus malalignment as well as foot malalignment can change the load applied to the knee.

Methods

PubMed literature search

Results

Inconsistent results for leg axis and the incidence of osteoarthritis of the knee are reported in the literature.

Conclusion

Leg axis and foot malpositioning are not causative factors.

     

Harnröhrenrekonstruktion bei vorausgegangener Hypospadieoperation

Background

The tasks involved in reconstructing the urethra after failed hypospadias repair range from correction of a trivial meatal stenosis to reconstruction of the entire anterior urethra.

Objectives

To describe pathological findings in the urethra after failed hypospadias repair and the respective surgical methods used for their correction.

Materials and methods

The various pathological findings after unsuccessful hypospadias surgery are classified according to their location and complexity.

Results

The general rules of reconstruction that should be applied in each particular situation are described.

Conclusions

Successful reconstruction of the urethra in patients with failed hypospadias surgery requires experience and good knowledge of the anatomy of the normal and hypospadic urethra and penis. Mastery of plastic surgical techniques and profound knowledge of the various surgical methods of hypospadias surgery are essential.

     

Notfallsonographischer Nachweis einer pulmonalen Arrosionsblutung bei Leitsymptom Thoraxschmerz und Dyspnoe

Background

The leading symptoms chest pain and acute dyspnea are frequent but nonspecific entities in emergency medicine which can mask a life-threatening differential diagnosis. To promptly identify the underlying disease and begin adequate treatment, point-of-care ultrasound—the use of mobile ultrasound equipment for immediate imaging—is becoming increasingly important for emergency physicians.

Results

After systematic training in ultrasound, transfer of knowledge is important for the physician to be in a position to detect previously unknown or rare findings that initiate crucial treatment changes. In the present case, the use of emergency ultrasound in a clinical context led to the detection of pulmonary artery bleeding and massive pleural effusion. This knowledge fundamentally and immediately resulted in a change of treatment.

Conclusion

Continuing education and qualification programs for emergency physicians in emergency sonography are necessary.

     

A multicentre investigation of organ and tissue donation education for critical care residents

Purpose

To describe critical care medicine residents’ training, expertise, and skills regarding organ and tissue donation processes and procedures.

Methods

We undertook a qualitative multicentre study and employed a purposive sample of program directors, physicians, nurses, residents, and organ donation leaders from all nine academic intensive care unit (ICU) training centres (five adult, four pediatric) in Ontario (n = 71). Interviews, conducted by telephone between December 2015 and March 2016, were audio-recorded and transcribed verbatim. Data collection and analysis were performed using an iterative process and continued until saturation was achieved.

Results

Five main themes were identified: 1) gaps in residents’ knowledge for both neurologic determination of death (NDD) and circulatory determination of death (DCD) cases; 2) commitment to the provision of organ and tissue donation training; 3) limited experiential learning (NDD and DCD); 4) challenges related to the provision of training on organ donation and need for a standardized curriculum; and 5) communication with family members. Overall, this study showed system-level gaps in training resulting from the lack of a standardized provincial curriculum on organ donation.

Conclusions

Qualitative data corroborated that residents need more exposure to clinical cases, especially regarding DCD donors. A standardized education curriculum would be beneficial for all residents within the ICU. Developing a better shared understanding of the donation process will improve team communication and performance, translate into a better end-of-life experience for families, and potentially result in increased donation rates.