Perceptions and expectations of cardiothoracic residents and attending surgeons

BackgroundWith our specialty going through a critical phase of re-evaluation and adaptation, our aim was to evaluate and compare the perceptions and expectations among residents and faculty regarding cardiothoracic training.MethodsA content-validated, 13-item survey was distributed electronically from August 14 to August 24, 2010 to 728 cardiothoracic surgery residents, recent program graduates (on or after June 2006), cardiothoracic surgery chairpersons, and program directors identified in the Cardiothoracic Surgery Network database.ResultsThe response rate was 34% (244 of 728). Of the respondents, 76% reported being “satisfied” or “very satisfied” with their program. Faculty willingness to teach in the operating room was ranked as the most valuable aspect of a training program, and strict adherence to the 80-h work week ranked as least valuable. Most respondents believed that a resident performing at least 75% of a case was acceptable for low-complexity procedures (92% of residents, 77% of attending physicians) and at least 25% for high-complexity procedures (91% of residents, 73% of attending physicians). However, residents wanted to perform more of the operations than the attending physicians considered necessary (P < 0.05). Finally, 63% of respondents (73% of residents, 56% of attending physicians) indicated that the increasing scrutiny of outcomes has adversely affected training. Other differences between the residents' and attending physicians' perceptions regarded the importance of participation in preoperative and postoperative care, what constitutes “scut work,” and the value of auxiliary staff.ConclusionsReconciling residents' expectations with the realities of duty-hour restrictions and high-stakes procedures will require the development of novel educational approaches to improve resident learning.     

Improving professionalism: making the implicit more explicit

PURPOSE: Professionalism is one of the most challenging of the Accreditation Council for Graduate Medical Education Competencies to define, teach and evaluate. At University of Washington we assessed whether defining professionalism, and training faculty and residents in the evaluation process would improve professional behavior. MATERIALS AND METHODS: In 2003 the Accreditation Council for Graduate Medical Education Global Resident Competency Rating Form was distributed to faculty after each rotation to evaluate residents. The project included all 16 residents and 18 clinical faculty during a total of 15 rotations for 3 years at 4 Seattle area hospitals. After 21 months a training lecture on professionalism was presented to faculty and residents. Following this intervention all trained faculty completed a Graduate Medical Education Global Resident Competency Rating Form on every resident after each rotation. Three specific professionalism questions from the Graduate Medical Education Global Resident Competency Rating Form were chosen as representations of standard professional behaviors. These questions were used to assess the change in resident professional behavior. RESULTS: Pre-intervention and post-intervention scores were compared. Mean post-intervention scores were higher by 0.4 to 0.5 points for each of the 3 questions (each p <0.01). There was less variation in scores after the intervention, suggesting that 1) residents were more consistent in their professional behavior and/or 2) the faculty observation of resident professional behaviors was more focused. CONCLUSIONS: These results suggest that training faculty and residents in professionalism may have a significant positive influence on improving resident professional behavior as well as the faculty ability to more objectively evaluate resident professional behaviors based on defined standards.     

Resident involvement in postoperative conversations: an underused opportunity

Background

Because of established attending-patient and family relationships and time constraints, residents are often excluded from the immediate postoperative conversation with family. Interpersonal and communication skills are a core competency, and the postoperative conversation is an opportunity to develop these skills. Our objective is to assess attitudes, experience, and comfort regarding resident participation during postoperative conversations with families.

Materials and methods

Residents and attending surgeons in an academic surgery center were surveyed regarding resident involvement in the postoperative conversation with families. Paper surveys were administered anonymously. Nonparametric statistics compared responses.

Results

There were 45 survey respondents (23 residents, 22 attendings). All residents rated postoperative conversations with families, as “important” or “very important”. Residents reported being “comfortable” or “very comfortable” with postoperative conversations. However, on average, residents reported fewer than 10 postoperative conversation experiences per year. Feedback was received by <30% on postoperative communication skills, but 88% wanted feedback. Most attendings reported it is “important” or “very important” for residents to communicate well with families during postoperative conversations, but rated residents' performance as significantly lower than the residents' self-assessments (P < 0.001). Attendings on average were only “somewhat comfortable” or “moderately comfortable” with residents conducting postoperative conversations with families, and only 68% reported allowing residents to do so. When bad news was involved, only 27% allowed resident participation. Most attendings (86%) believed residents need more opportunities with postoperative conversations.

Conclusions

Although most residents reported being comfortable with postoperative conversations, these survey results indicate that they have few opportunities. Developing a workshop on communication skills focused on the postoperative conversations with families may be beneficial.     

Professionalism in anesthesia

Purpose

Is professionalism in medicine just another bureaucratic imposition on our practice or a fundamental concept for physicians at all stages in their career? In this review, the historical perspectives of professionalism are explored as well as the what, why, and how questions concerning this topic.

Source

The key words “professionalism” and “anesthesia” were used to conduct a search of the PubMed database, the policies and publications of relevant Canadian and international physician regulatory bodies and organizations, historical documents, and other internet publications.

Principal findings

Professionalism in anesthesia has a long history. While there are many definitions for professionalism, some very dated, all are based on virtues, behaviour, or professional identity. Professionalism plays a central role in the balance between physician autonomy and social contract, and it has a significant impact on patient safety and medicolegal litigation.

Conclusion

Considerable evidence exists to suggest that professionalism must be treated seriously, particularly in these times of social accountability and budgetary pressures.

     

How learning preferences and teaching styles influence effectiveness of surgical educators

BackgroundEffective surgical educators have specific attributes and learner-relationships. Our aim was to determine how intrinsic learning preferences and teaching styles affect surgical educator effectiveness.MethodsWe determined i) learning preferences ii) teaching styles and iii) self-assessment of teaching skills for all general surgery attendings. All general surgical residents in our program completed teaching evaluations of attendings.ResultsMultimodal was the most common learning preference (20/28). Although the multimodal learning preference appears to be associated with more effective educators than kinesthetic learning preferences, the difference was not statistically significant (80.0% versus 66.7%, p = 0.43). Attendings with Teaching Style 5 were more likely to have a lower “professional attitude towards residents” score on SETQ assessment by residents (OR 0.33 (0.11, 0.96), p = 0.04). Attendings rated their own “communication of goals” (p < 0.001), “evaluation of residents” (p = 0.04) and “overall teaching performance” (p = 0.01) per STEQ domains as significantly lower than the resident’s assessment of these cofactors.ConclusionIdentification of factors intrinsic to surgical educators with high effectiveness is important for faculty development. Completion of a teaching style self-assessment by attendings could improve effectiveness.     

Career decisions,training priorities,and perceived challenges for anesthesiology residents in the United States

Study objectiveThis study sought to understand the timing and important factors identified by residents regarding their decision to pursue a career in anesthesiology, training areas deemed important to their future success, perceived greatest challenges facing the profession of anesthesiology, and their post-residency plans.DesignThe American Board of Anesthesiology administered voluntary, anonymous, repeated cross-sectional surveys to residents who began clinical anesthesia training in the U.S. from 2013 to 2016 and were subsequently followed up yearly until the completion of their residency. The analyses included data from 12 surveys (4 cohorts from clinical anesthesia years 1 to 3), including multiple-choice questions, rankings, Likert scales, and free text responses. Free responses were analyzed using an iterative inductive coding process to determine the main themes.Main resultsThe overall response rate was 36% (6480 responses to 17,793 invitations). Forty-five percent of residents chose anesthesiology during the 3rd year of medical school. “Nature of the clinical practice of anesthesiology” was the most important factor influencing their decision (average ranking of 5.93 out of 8 factors, 1 [least important] to 8 [most important]), followed by “ability to use pharmacology to acutely manipulate physiology” (5.75) and “favorable lifestyle” (5.22). “Practice management” and “political advocacy for anesthesiologists” (average rating 4.46 and 4.42, respectively, on a scale of 1 [very unimportant] to 5 [very important]) were considered the most important non-traditional training areas, followed by “anesthesiologists as leaders of the perioperative surgical home” (4.32), “structure and financing of the healthcare system” (4.27), and “principles of quality improvement” (4.26). Three out of 5 residents desired to pursue a fellowship; pain medicine, pediatric anesthesiology, and cardiac anesthesiology were the most popular choices, each accounting for approximately 20% of prospective fellows. Perceived greatest challenges facing the profession of anesthesiology included workforce competition from non-physician anesthesia providers and lack of advocacy for anesthesiologist values (referenced by 96% of respondents), changes and uncertainty in healthcare systems (30%), and personal challenges such as psychological well-being (3%).ConclusionsMost residents identified anesthesiology as their career choice during medical school. Interest in non-traditional subjects and fellowship training was common. Competition from non-physician providers, healthcare system changes, and compromised psychological well-being were perceived concerns.     

Can professionalism be taught? Encouraging evidence

Background

Teaching and assessing the Accreditation Council for Graduate Medical Education (ACGME) competencies of Professionalism and Communication have proven to be a challenge for surgical residency training programs. This study used innovative pedagogic approaches and tools in teaching these two competencies. The purpose of this study was to determine whether the learners actually are assimilating and using the concepts and values communicated through this curriculum.

Methods

A six-station Objective Structured Clinical Examination (OSCE) was designed using standardized patients to create varying Professionalism and Communication scenarios. The surgical resident learners were evaluated using these OSCEs as a baseline. The faculty then facilitated a specially designed curriculum consisting of six interactive sessions focusing on information gathering, rapport building, patient education, delivering bad news, responding to emotion, and interdisciplinary respect. At the conclusion of this curriculum, the surgical resident learners took the same six-station OSCE to determine if their professionalism and communication skills had improved.

Results

The surgical resident learners were rated by the standardized patients according to a strict task checklist of criteria at both the precurricular and postcurricular OSCEs. Improvement in the competencies of Professionalism and Communication did achieve statistical significance (P = .029 and P = .011, respectively).

Conclusions

This study suggests that the Communication and Professionalism ACGME competencies can be taught to surgical resident learners through a carefully crafted curriculum. Furthermore, these newly learned competencies can affect surgical resident interactions with their patients positively.     

Content analysis of resident evaluations of faculty anesthesiologists: supervision encompasses some attributes of the professionalism core competency

Background

Anesthesiology departments need an instrument with which to assess practicing anesthesiologists’ professionalism. The purpose of this retrospective analysis of the content of a cohort of resident evaluations of faculty anesthesiologists was to investigate the relationship between a clinical supervision scale and the multiple attributes of professionalism.

Methods

From July 1, 2013 to the present, our department has utilized the de Oliveira Filho unidimensional nine-item supervision scale to assess the quality of clinical supervision of residents provided by our anesthesiologists. The “cohort” we examined included all 13,664 resident evaluations of all faculty anesthesiologists from July 1, 2013 through December 31, 2015, including 1,387 accompanying comments. Words and phrases associated with the core competency of professionalism were obtained from previous studies, and the supervision scale was analyzed for the presence of these words and phrases.

Results

The supervision scale assesses some attributes of anesthesiologists’ professionalism as well as patient care and procedural skills and interpersonal and communication skills. The comments that residents provided with the below-average supervision scores included attributes of professionalism, although numerous words and phrases related to professionalism were not present in any of the residents’ comments.

Conclusions

The de Oliveira Filho clinical supervision scale includes some attributes of anesthesiologists’ professionalism. The core competency of professionalism, however, is multidimensional, and the supervision scale and/or residents’ comments did not address many of the other established attributes of professionalism.

     

Anesthesiology resident personality type correlates with faculty assessment of resident performance

Study ObjectiveTo study the association between anesthesiology residents' personality preference types, faculty evaluations of residents' performance, and knowledge.DesignConvenience sample and prospective study.SettingAcademic department of anesthesiology.SubjectsConsenting anesthesiology residents (n = 36).InterventionsAll participants completed the Myers Briggs Type Indicator® (MBTI®).MeasurementsAll residents' 6-month summation of daily focal evaluations completed by faculty [daily performance score (DPS); 1 = unsatisfactory, 2 = needs improvement, 3 = meets expectations, 4 = exceeds expectations], as well as a global assessment of performance (GAP) score based on placement of each resident into perceived quartile compared with their peers (ie,1 = first, or top, quartile) by senior faculty (n = 7) who also completed the MBTI, were obtained. The resident MBTI personality preferences were compared with the DPS and GAP scores, the United States Medical Licensing Examination (USMLE) I and II scores, and faculty MBTI personality type.Main ResultsThere was no association between personality preference type and performance on standardized examinations (USMLE I, II). The mean GAP score was better (higher quartile score) for Extraverts than Introverts (median 2.0 vs 2.6, P = 0.0047) and for Sensing versus Intuition (median 2.0 vs 2.6, P = 0.0206) preference. Faculty evaluator MBTI preference type did not influence the GAP scores they assigned residents. Like GAP, the DPS was better for residents with Sensing versus Intuition preference (median 3.5 vs 3.3, P = 0.0111). No difference in DPS was noted between Extraverts and Introverts.ConclusionsPersonality preference type was not associated with resident performance on standardized examinations, but it was associated with faculty evaluations of resident performance. Residents with Sensing personality preference were evaluated more favorably on global and focal faculty evaluations than those residents who chose the Intuition preference. Extraverted residents were evaluated more favorably on global but not focal assessment of performance.     

Get on your boots: Preparing fourth-year medical students for a career in surgery, using a focused curriculum to teach the competency of professionalism

IntroductionFew educational programs exist for medical students that address professionalism in surgery, even though this core competency is required for graduate medical education and maintenance of board certification. Lapses in professional behavior occur commonly in surgical disciplines, with a negative effect on the operative team and patient care. Therefore, education regarding professionalism should begin early in the surgeon's formative process, to improve behavior. The goal of this project was to enhance the attitudes and knowledge of medical students regarding professionalism, to help them understand the role of professionalism in a surgical practice.MethodsWe implemented a 4-h seminar, spread out as 1-h sessions over the course of their month-long rotation, for 4th-year medical students serving as acting interns (AIs) in General Surgery, a surgical subspecialty, Obstetrics/Gynecology, or Anesthesia. Teaching methods included lecture, small group discussion, case studies, and journal club. Topics included Cognitive/Ethical Basis of Professionalism, Behavioral/Social Components of Professionalism, Managing Yourself, and Leading While You Work. We assessed attitudes about professionalism with a pre-course survey and tracked effect on learning and behavior with a post-course questionnaire. We asked AIs to rate the egregiousness of 30 scenarios involving potential lapses in professionalism.ResultsA total of 104 AIs (mean age, 26.5 y; male to female ratio, 1.6:1) participated in our course on professionalism in surgery. Up to 17.8% of the AIs had an alternate career before coming to medical school. Distribution of intended careers was: General Surgery, 27.4%; surgical subspecialties, 46.6%; Obstetrics/Gynecology, 13.7%; and Anesthesia, 12.3%. Acting interns ranked professionalism as the third most important of the six core competencies, after clinical skills and medical knowledge, but only slightly ahead of communication. Most AIs believed that professionalism could be taught and learned, and that the largest obstacle was not enough time in the curriculum. The most effective reported teaching methods were mentoring and modeling; lecture and journal club were the effective. Regarding attitudes toward professionalism, the most egregious examples of misconduct were substance abuse, illegal billing, boundary issues, sexual harassment, and lying about patient data, whereas the least egregious examples were receiving textbooks or honoraria from drug companies, advertising, self-prescribing for family members, and exceeding work-hour restrictions. The most important attributes of the professional were integrity and honesty, whereas the least valued were autonomy and altruism. The AIs reported that the course significantly improved their ability to define professionalism, identify attributes of the professional, understand the importance of professionalism, and integrate these concepts into practice (all P < 0.01).ConclusionsAlthough medical students interested in surgery may already have well-formed attitudes and sophisticated knowledge about professionalism, this core competency can still be taught to and learned by trainees pursuing a surgical career.     

Identification of promotion and prevention associated surgeon behaviors in the operating room to facilitate resident self-regulated learning

BackgroundThe regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles.Methods10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors.ResultsThere is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of “works quickly,” “high energy,” and “mostly provides broad oversight,” and for the prevention-associated behaviors of “works slowly and deliberately,” “quiet and calm,” and “preference for vigilant strategies.”ConclusionResidents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.     

How Effective are New Milestones Assessments at Demonstrating Resident Growth? 1 Year of Data

Objective

Assessment tools that accrue data for the Accreditation Council for Graduate Medical Education Milestones must evaluate residents across multiple dimensions, including medical knowledge, procedural skills, teaching, and professionalism. Our objectives were to: (1) develop an assessment tool to evaluate resident performance in accordance with the Milestones and (2) review trends in resident achievements during the inaugural year of Milestone implementation.

Interactive anesthesiology educational program improves wellness for anesthesiologists and their children

Study objectiveAnesthesiologists have a high prevalence of burnout with adverse effects on professionalism and safety. The objective of this study was to assess the impact of an interactive anesthesiology educational program on the wellness of anesthesia providers and their children, as assessed by a modified Professional Fulfillment Index.DesignProspective observational study.SettingPerioperative area.PatientsThirty clinicians participated in the program. Twenty respondents, representing 67% of participants and each corresponding to a parent and their child or children, completed the post-event survey.InterventionsAn interactive anesthesiology educational program incorporating children, between the ages of five and eighteen years old, of anesthesia providers was held in the perioperative area. The program was held over four hours and was comprised of four sessions including pediatric anesthesia, neuroanesthesia, airway, and ultrasound stations.MeasurementsAnesthesia providers and their children were administered a post-event assessment, including a modified Professional Fulfillment Index and satisfaction survey.Main resultsAll twenty (100%) of respondents indicated it was “very true” or “completely true” that their child was happy with the program, and that it was worthwhile and satisfying to both the anesthesia provider and their child. Nineteen (95%) of reporting participants indicated it was “very true” or “completely true” that it was meaningful to have the department host such a program and 17 (85%) respondents felt their child now better understands the anesthesia work of the parent. All clinician volunteers indicated it was “very true” or “completely true” that they were contributing professionally during the program in ways that they valued most.ConclusionAn interactive educational wellness initiative provides an effective and feasible method for increasing professional fulfillment and satisfaction among anesthesia providers while educating our youngest generation of learners. Implementation of such a program may also occur with modifications such as televideo to maintain COVID-19 precautions.     

A preliminary review of a pilot curriculum to teach open surgical skills during general surgery residency with initial feedback

IntroductionThe aim of this study is to provide a preliminary review of a pilot curriculum to teach open surgical skills during general surgery residency and obtain initial feedback.Data sourceThe general surgery residency program introduced an open surgical skills training curriculum in 2009. The skills sessions are undertaken under the guidance of the faculty. An annual survey was distributed to the residents and faculty to obtain their feedback.ConclusionsA total of 50 sessions were conducted over the last 2 years. Ninety-five percent of the residents perceived this educational activity to be above average to exceptional with nearly 70% rating it as exceptional. Sixty-three percent of the faculty perceived it as above average to exceptional, with nearly 40% rating it as exceptional. The open surgical skills training curriculum was rated as the most educational activity in the program by residents and faculty alike.     

Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load

Study ObjectiveTo measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a “good-excellent” level of competence.DesignProspective study.SettingOperating room of a university hospital.Subjects7 volunteer residents in anesthesiology.MeasurementsResidents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual’s ability was based on the resident’s self-assessment score and the attending anesthesiologist’s judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures).Main ResultsEach task had a specific learning rate; the number of procedures necessary to achieve “good-excellent” ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management.ConclusionsAwake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides “good-excellent” ability.     

Greater faculty familiarity with residents improves intraoperative entrustment

BackgroundLongitudinal contact between faculty and residents facilitates greater faculty entrustment. The purpose of this study is to assess the relationship between faculty familiarity with residents and faculty entrustment.Materials and methodsResearchers observed and rated entrustment behaviors using OpTrust, September 2015–June 2017 at Michigan Medicine. Faculty familiarity with resident was measured on a 1–4 scale (1 = not familiar, 4 = extremely familiar). ANOVA and Sidak adjusted multiple comparisons were used to assess the relationship between faculty familiarity and faculty entrustment.Results56 faculty and 73 residents were observed across 225 surgical cases. Faculty entrustment scores increased to 2.48 when resident familiarity was reported as “slightly familiar”. Faculty entrustment scores for “moderately familiar” increased to 2.57. Faculty entrustment scores for “extremely familiar” increased to 2.84.ConclusionsWe found a positive relationship between faculty familiarity and entrustment. These findings support greater continuity in faculty/resident relationships. Longitudinal contact allows learners to be granted progressive entrustment.SummaryThis study demonstrates a positive relationship between faculty familiarity with residents and an increase in intraoperative entrustment. These findings support greater continuity in faculty/resident relationships.     

Residency program directors' perceptions about the impact of the American Board of Anesthesiology's Objective Structured Clinical Examination

Study objectiveTo describe how the introduction of an Objective Structured Clinical Examination (OSCE) by the American Board of Anesthesiology (ABA) to its initial certification impacted anesthesiology residencies in the United States.Design and settingA sequential mixed-methods design with focus groups and online survey among program directors of Accreditation Council for Graduate Medical Education-accredited anesthesiology residencies.PatientsNo patients were included.InterventionNone.MeasurementsA convenience sample of 34 program directors were interviewed to understand their perceptions of the ABA OSCE. Subsequently, an online survey, based on major themes identified from the focus groups, was sent to all 156 program directors.Main resultsSeveral themes emerged from the focus group discussions: (1) a mock OSCE was most common for preparing residents for the ABA OSCE; 2) the ABA OSCE led to changes in residency curriculum; 3) the ABA OSCE assessed communication and professionalism skills well, and how well it assessed technical skills was less agreed on. Survey results from 87 program directors (response rate = 56%) were mostly consistent with the themes generated by the focus groups. Eight-one out of 87 programs (93%) specifically prepared their residents for the ABA OSCE. Fifty-two out of 81 program directors (64%) reported the introduction of the ABA OSCE led to curricular changes. Out of 79 program directors, 45 (57%) agreed the ABA OSCE assesses skills essential to anesthesiology practice, and 40 (51%) considered it added value to board certification.ConclusionsThe introduction of the OSCE by the ABA for board certification has affected the curriculum of many residencies. Approximately 3 in 5 program directors perceived the ABA OSCE measures skills essential to anesthesiologists' practice. Future studies should assess residency graduates' perspective on the usefulness of both mock OSCE preparation and the ABA OSCE, and whether the ABA OSCE performance predicts future clinical practice.     

Visualization of aggregate perioperative data improves anesthesia case planning: A randomized,cross-over trial

Study objectiveA challenge in reducing unwanted care variation is effectively managing the wide variety of performed surgical procedures. While an organization may perform thousands of types of cases, privacy and logistical constraints prevent review of previous cases to learn about prior practices. To bridge this gap, we developed a system for extracting key data from anesthesia records. Our objective was to determine whether usage of the system would improve case planning performance for anesthesia residents.DesignRandomized, cross-over trial.SettingVanderbilt University Medical Center.MeasurementsWe developed a web-based, data visualization tool for reviewing de-identified anesthesia records. First year anesthesia residents were recruited and performed simulated case planning tasks (e.g., selecting an anesthetic type) across six case scenarios using a randomized, cross-over design after a baseline assessment. An algorithm scored case planning performance based on care components selected by residents occurring frequently among prior anesthetics, which was scored on a 0–4 point scale. Linear mixed effects regression quantified the tool effect on the average performance score, adjusting for potential confounders.Main resultsWe analyzed 516 survey questionnaires from 19 residents. The mean performance score was 2.55 ± SD 0.32. Utilization of the tool was associated with an average score improvement of 0.120 points (95% CI 0.060 to 0.179; p < 0.001). Additionally, a 0.055 point improvement due to the “learning effect” was observed from each assessment to the next (95% CI 0.034 to 0.077; p < 0.001). Assessment score was also significantly associated with specific case scenarios (p < 0.001).ConclusionsThis study demonstrated the feasibility of developing of a clinical data visualization system that aggregated key anesthetic information and found that the usage of tools modestly improved residents' performance in simulated case planning.