Anesthesiology Resident Performance on the US Medical Licensing Examination Predicts Success on the American Board of Anesthesiology BASIC Staged Examination: An Observational Study

BACKGROUND: Correlation has been found between the US Medical Licensing Examination (USMLE) Step 1 examination results and anesthesiology resident success on American Board of Anesthesiology (ABA) examinations. In 2014, the ABA instituted the BASIC examination at the end of the postgraduate year-2 year. We hypothesized a similar predictive value of USMLE scores on BASIC examination success. METHODS: After the Committee for the Protection of Human Subjects at UTHealth Institutional Review Board approved and waived written consent, we retrospectively evaluated USMLE Step examination performance on first-time BASIC examination success in a single academic department from 2014-2018. RESULTS: Over 5 years, 120 residents took the ABA BASIC examination and 108 (90%) passed on the first attempt. Ten of 12 first-time failures were successful on repeat examination but analyzed in the failure group. Complete data was available for 92 residents (76.7%), with absent scores primarily reflecting osteopathic graduates who completed Comprehensive Osteopathic Medical Licensing Examination of the United States level examinations rather than USMLE. In the failure cohort, all 3 USMLE examination step scores were lower ( CONCLUSIONS: In anesthesiology residency training, our preliminary single-center data is the first to suggest that USMLE Step 1 performance could be used as a predictor of success on the recently introduced ABA BASIC Examination. These findings do not support recent action to change USMLE scoring to a pass/fail report

Characteristics of Academic Anesthesiologist’s Elected to an Institutional Academy of Master Educators

Background. The educational experience and success of academic anesthesiologists may be elusive to quantify. We wished to examine the characteristics of a cohort of anesthesiology faculty who were inducted into a medical school master educator academy over the last decade. Methods. After IRB approval with waiver of consent, all 10 anesthesiology faculty inductees into the academy supplied relevant data for their accomplishments at the time of induction in multiple educational domains, including teaching and assessment, mentoring and advising, evidence of scholarship and production of enduring materials, and educational leadership. These were deidentified and analyzed. Results. The cohort had evidence of a consistent, visible footprint in the department, medical school, affiliated associations and state and national professional organizations. These included educational leadership positions, numerous teaching recognition and awards, substantial committee service, active mentorship exceeding usual faculty effort and robust portfolios of publications and presentations related to teaching and/or incorporating and supporting mentees as co-authors. Neither time in rank or academic progress was a limitation with several achieving induction in \u3c 5 years. Conclusions. It is possible for full-time anesthesiology clinicians to achieve success in educational recognition within the medical school body. This summary of characteristics of one department’s cohort may be useful to others seeking such recognition and serve. Based on the aggregate findings, we make recommendations for faculty wishing to pursue excellence in education

Volatile Anesthetic and Outcome in Acute Trauma Care: Planned Secondary Analysis of the PROPPR Study

BACKGROUND: This retrospective analysis of prospectively collected data from the PROPPR study describes volatile anesthetic use in severely injured trauma patients undergoing anesthesia. METHODS: After exclusions, 402 subjects were reviewed of the original 680, and 292 had complete data available for analysis. Anesthesia was not protocolized, so analysis was of contemporary practice. RESULTS: The small group who received no volatile anesthetic (n = 25) had greater injury burden (Glasgow Coma Scale CONCLUSION: In this acutely injured trauma population, choice of volatile anesthetic did not appear to influence short-term mortality and morbidity. Subjects who received no volatile were more severely injured with greater mortality, representing hemodynamic compromise where volatile agent was limited until stable. As anesthetic was not protocolized, these findings that choice of specific volatile was not associated with short-term survival require prospective, randomized evaluation

Pro-Con Debate: Prehospital Blood Transfusion-Should It Be Adopted for Civilian Trauma?

Exsanguination is the leading cause of death in severely injured patients; nevertheless, prehospital blood transfusion (PHT) remains a controversial topic. Here, we review the pros and cons of PHT, which is now routine in treatment of military trauma patients in the civilian setting. While PHT may improve survival in those who suffer blunt injury or require prolonged transport from the site of injury, PHT for civilian trauma generally is not supported by high-quality evidence. This article was originally presented as a pro-con debate at the 2020 meeting of the European Society of Anesthesiology and Intensive Care

Heparin Content of Cell-Salvaged Blood After Cardiopulmonary Bypass

Blood remaining in the extracorporeal circuit (ECC) is frequently concentrated and washed before transfusion to the patient after termination of cardiopulmonary bypass. As additional doses of protamine are often administered to reverse the effects of suspected heparin content of this blood, we determined activated clotting times (ACTs) and heparin concentration pre and post cell salvaged blood administration. After a I liter normal saline wash, administration of the cells obtained using the Cobe Baylor Rapid Autologous Transfusion (BRAT) system caused no change in either patient ACT (p=0.19) or plasma heparin concentrations. We conclude that additional protamine administration is unwarranted after transfusion of concentrated, washed red blood cells (RBCs) from the ECC with the Cobe BRAT cell salvage device