6 research outputs found
Blockage of the tracheal bronchus: effects on blood oxygen content, partial pressure of oxygen, and intrapulmonary shunt
Separate circuit nasal cannulae for end-tidal CO2 monitoring may lead to hypoxia in patients with unilateral nasal airway obstruction
Examining the accuracy of residents’ self-assessments and faculty assessment behaviours in anesthesiology
Background: Residents’ accurate self-assessment and clinical judgment are essential for optimizing their clinical skills development. Evidence from the medical literature suggests that residents generally do poorly at self-assessing their performance, often due to factors relating to learners’ personal backgrounds, cultures, the specific contexts of the learning environment and rater bias or inaccuracies. We evaluated the accuracy of anesthesiology residents’ self-assessed Global Entrustment scores and determined whether differences between faculty and resident scores varied by resident seniority, faculty leniency, and/or year of assessment.Methods: We employed variance components modeling techniques and analyzed 329 pairs of faculty and self-assessed entrustment scores among 43 faculty assessors and 15 residents. Using faculty scores as the gold standard, we compared faculty scores with residents’ scores (xi(faculty)–xi(resident)), and determined residents’ accuracy, including over- and under-confidence.Results: The results indicate that residents were respectively over- and under-confident in 10.9% and 54.4% of the assessments but more consistent in their individual self-assessments (rho = 0.70) than faculty assessors. Faculty scores were significantly higher (α = 0.396; z = 4.39; p < 0.001) than residents’ self-assessed scores. Being a lenient/dovish (β = 0.121, z = 3.16, p < 0.01) and a neutral (β = 0.137, z = 3.57, p < 0.001) faculty assessor predicted a higher likelihood of resident under-confidence. Senior residents were significantly less likely to be under-confident compared to junior residents (β = -0.182, z =-2.45, p < 0.05). The accuracy of self-assessments did not significantly vary during the two years of the study period.Conclusions: The majority of residents’ self-assessments were inaccurate. Our findings may help identify the sources of such inaccuracies.Contexte : L'autoévaluation adéquate et le jugement clinique des résidents sont essentiels pour optimiser le développement de leurs compétences cliniques. Les données probantes de la littérature médicale indiquent que les résidents ont généralement du mal à s’auto-évaluer, souvent en raison de facteurs liés à leur passé personnel, à la culture, aux contextes spécifiques de l'environnement d'apprentissage et aux préjugés ou inexactitudes des évaluateurs. Nous avons évalué l'exactitude des scores d'autoévaluation par échelles de confiance globalepar des résidents en anesthésiologie et déterminé si les différences entre les scores des enseignants et des résidents variaient en fonction du niveau de formation des résidents, de l'indulgence des enseignants ou de l'année d'évaluation.Méthodes : Nous avons utilisé des techniques de modélisation des composantes de la variance et analysé 329 paires de scores de confiance des enseignants et d'autoévaluation avec la participation de 43 évaluateurs du corps professoral et 15 résidents. Prenant les scores des enseignants comme référence, nous avons comparé les leurs avec ceux des résidents (xi(enseignant) -xi(résident)), et déterminé l’exactitude chez les résidents, y compris l'excès et le manque de confiance.Résultats : Les résultats indiquent que les résidents étaient trop confiants dans 10,9 % des évaluations, et pas assez confiants dans 54,4 % des cas, mais qu’ils étaient plus cohérents dans leurs autoévaluations (rho = 0,70) que ne l’étaient les enseignants. Les scores du corps professoral étaient significativement plus élevés (α = 0,396 ; z = 4,39 ; p < 0,001) que les scores d'autoévaluation des résidents. Le fait d'être un évaluateur indulgent (β = 0,121, z = 3,16, p < 0,01) et neutre (β = 0,137, z = 3,57, p < 0,001) prédisait une probabilité plus élevée de sous-confiance des résidents. Les résidents seniors étaient significativement moins susceptibles de manquer de confiance en eux que les résidents juniors (β = -0,182, z = -2,45, p < 0,05). L'exactitude des autoévaluations n'a pas varié de manière significative au cours des deux années de la période d'étude.Conclusions : La majorité des autoévaluations des résidents étaient inexactes. Nos résultats peuvent aider à identifier les sources de ces inexactitudes
Knowledge retention after focused cardiac ultrasound training: a prospective cohort pilot study
Background and objectives: Focused Cardiac Ultrasound (FoCUS) has proven instrumental in guiding anesthesiologists’ clinical decision-making process. Training residents to perform and interpret FoCUS is both feasible and effective. However, the degree of knowledge retention after FoCUS training remains a subject of debate. We sought to provide a description of our 4-week FoCUS curriculum, and to assess the knowledge retention among anesthesia residents at 6 months after FoCUS rotation. Methods: A prospective analysis involving eleven senior anesthesia residents was carried out. At end of FoCUS Rotation (EOR) participants completed a questionnaire (evaluating the number of scans completed and residents’ self-rated knowledge and comfort level with FoCUS), and a multiple-choice FoCUS exam comprised of written- and video-based questions. Six months later, participants completed a follow-up questionnaire and a similar exam. Self-rated knowledge and exam scores were compared at EOR and after 6 months. Spearman correlations were conducted to test the relationship between number of scans completed and exam scores, perceived knowledge and exam scores, and number of scans and perceived knowledge. Results: Mean exam scores (out of 50) were 44.1 at EOR and 43 at the 6-month follow-up. Residents had significantly higher perceived knowledge (out of 10) at EOR (8.0) than at the 6-month follow-up (5.5), p = 0.003. At the EOR, all trainees felt comfortable using FoCUS, and at 6 months 10/11 still felt comfortable. All the trainees had used FoCUS in their clinical practice after EOR, and the most cited reason for not using FoCUS more frequently was the lack of perceived clinical need. A strong and statistically significant (rho = 0.804, p = 0.005) correlation between number of scans completed during the FoCUS rotation and 6-month follow-up perceived knowledge was observed. Conclusion: Four weeks of intensive FoCUS training results in adequate knowledge acquisition and 6-month knowledge retention. Resumo: Justificativa e objetivos: A ultrassonografia cardíaca no local de atendimento (USCLA) provou ser importante para orientar o processo de tomada de decisão clínica dos anestesiologistas. Treinar os residentes para fazer e interpretar uma USCLA é viável e eficaz. No entanto, o grau de retenção do conhecimento após o treinamento permanece um assunto de debate. Procuramos fornecer uma descrição do currículo de quatro semanas do treinamento de USCLA e avaliar a retenção do conhecimento entre os residentes de anestesia seis meses após a rotação em USCLA. Métodos: Uma análise prospectiva foi realizada com 11 residentes seniores de anestesia. Ao final da rotação em USCLA, os participantes preencheram um questionário (avaliando o número de exames ultrassonográficos concluídos, o conhecimento adquirido e o nível de conforto dos residentes com a USCLA) e fizeram um exame de múltipla escolha para USCLA, composto por perguntas escritas e baseadas em vídeo. Seis meses depois, os participantes preencheram um questionário de acompanhamento e um exame similar. A autoavaliação do conhecimento e os escores do exame foram comparados no final da rotação e após seis meses. Correlações de Spearman foram usadas para testar a relação entre o número de exames concluídos e os escores dos exames, o conhecimento percebido, os escores dos exames, o número de exames e o conhecimento percebido. Resultados: Os escores médios dos exames (50) foram: 44,1 no final da rotação e 43 após seis meses. Os residentes tiveram conhecimento percebido significativamente maior (10) no final da rotação (8,0) que após seis meses (5,5), p = 0,003. No final da rotação, todos os residentes se sentiram confortáveis usando o aparelho de USCLA e, aos seis meses, 10/11 ainda se sentiam confortáveis. Todos os residentes haviam usado o USCLA em sua prática clínica após o final da rotação e a razão mais citada para não usar o USCLA com mais frequência foi a falta de necessidade clínica percebida. Uma correlação forte e estatisticamente significativa (rho = 0,804, p = 0,005) foi observada entre o número de exames realizados durante a rotação em USCLA e o conhecimento percebido em seis meses de seguimento. Conclusão: Quatro semanas de treinamento intensivo de USCLA resultaram em aquisição e retenção adequadas do conhecimento por seis meses. Keywords: POCUS, FoCUS, Knowledge retention, Education, Anesthesia, Palavras-chave: POCUS, USCLA, Retenção de conhecimento, Educação, Anestesi