Browsing by Author "Boyer, Tanna"

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    Breast Pumping in the Healthcare Workplace
    (2023-11-04) Yu, Corinna; Boyer, Tanna; Mitchell, Sally
    Background: Reasons women do not breastfeed, or shorten their breastfeeding journey, include the lack of paid leave and the challenges of breast pumping in the healthcare workplace. Despite the health benefits of breastfeeding for mother and baby, health care workers returning to work often struggle to breast pump due to lack of access to lactation facilities and lack of time and support. The aim of this needs assessment was to determine the extent of these challenges. Methods: A survey was created and distributed through social media forums from 2020-2023 to determine the extent of these issues. IRB exemption was obtained (Protocol #2010273689). Responses were obtained from 222 health care workers across the United States. Data were analyzed and comments were sorted thematically.  Results: Survey respondents were from the Midwest 30% (66), Southeast 25% (55), Northeast 18% (40), West 16% (35), and Southwest 10% (22) with 222 total responses. Physicians (n = 191) made up 86% of the responses across 11 specialties, with 15 of them being residents or fellows. There were 50% of respondents who did not have nearby access to a lactation room although 96% used a breast pump while at work. Pumping occurred every 2-3 hours for 48% and every 4-6 hours for 48% of respondents. Pumping duration was 11-20 minutes for 53% and 21-30 minutes for 32% of respondents, with transit time and other logistics taking an additional 1-5 minutes for 33%, 6-10 minutes for 47%, and 11-15 minutes for 12% of respondents. On a scale of 1-5, where 1 was “Pumping at work did not affect the duration of breastfeeding at all” and 5 was “I had to stop breastfeeding because I was not able to pump enough at work,” responses were 1 (19%), 2 (23%), 3 (20%), 4 (19%), 5 (19%). Respondents (n = 106; 48%) have used a wearable breast pump. On a scale from 1 to 10, where 1 is “No, I CAN NOT do my job equally well when wearing a breast pump” and 10 is “Yes, I CAN do my job equally well when wearing a breast pump,” 49% of those respondents chose 10. In the free text comments, multiple respondents discussed pumping while providing clinical care using wearable pumps. One person pumped while performing a vaginal delivery, another during an intraoperative code, and another while placing lines for a patient with a Type A aortic dissection. Discussion: Lack of access to lactation facilities, long transit times, frequent pumping, and long pumping sessions can be time prohibitive challenges for many health care workers. Lack of support from colleagues, administrators, and patients can influence breastfeeding duration. Wearable breast pumps have mixed reviews but have allowed many women to pump while doing normal work activities. Although only 107 respondents (48%) have used wearable breast pumps, 148 respondents (67%) answered “Does a wearable breast pump affect your ability to perform your job effectively?” suggesting opinions instead of personal experience. “Nearby access” of lactation facilities was not defined. The scope of work may differ from health care providers who do telemedicine, see patients in clinic, or perform codes in the operating room. Improvements on this survey include specifying the states for each US region and clarifying the year when respondents were breast pumping, as culture has evolved with a greater emphasis on wellness and increased numbers of women physicians. Expanding data on trainees would identify issues related to autonomy and educational practices. Conclusion: Accessible lactation rooms are lacking in the healthcare workplace. On average, respondents pumped every 2-6 hours with the majority taking 11-30 mins with 1-15 mins for logistics. Wearable breast pumps may be a viable option for some women to continue work activities while pumping. Workplace bias against breast pumping is still prevalent and more work needs to be done to support breast pumping women.
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    Cardiac Tamponade: An Adult Simulation for CA1 Residents
    (2020-09-12) Tenbarge, Madison; Boles, Brady; Geiser, Matthew; Mercho, Raphael; Boyer, Tanna
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    Career Mentors & 5-Year Data on the IUSM Anesthesiology Match
    (2022-04-28) Yu, Corinna; Ye, Jian; Boyer, Tanna; Mitchell, Sally
    Introduction: The IU Department of Anesthesia provides Anesthesiology Career Mentors to 3rd and 4th year medical students. We have approximately 47 requests per class year. In the past 5 years, we have matched 181 students into Anesthesiology, averaging 36 students per year (range 30-46). Where do these students match into Anesthesiology? How many of them use the Career Mentorship program? If they don’t choose Anesthesiology, which other specialties appeal to them? Objective: The purpose of this presentation is to examine the pipeline of students interested in anesthesiology who request a career mentor and match into anesthesiology. Methods: Match data from publicly obtained IUSM Graduation Booklets for the Class of 2017 through 2021 was filtered for those students matching into Anesthesiology Residency Programs. These programs were mapped and cross-referenced for medical school rankings based on the 2022 US News & World Report Medical School Rankings for Research. Anesthesiology career mentorship requests were tracked starting in 2019 for the class of 2020 onwards, so students who matched into Anesthesiology were cross-referenced with students who had formally requested Anesthesiology Career Mentors in 2020 and 2021. Students who had formally requested Anesthesiology Career Mentors in 2020 and 2021 were also cross-referenced with the IUSM Graduation Booklet data to see how many of these students matched into Anesthesiology or other fields. Results: Of the 181 students that have matched into Anesthesiology from 2017-2021, 63 students matched at IU (35%). The rest are distributed across the regions of the US, including residency programs at the top 25 medical schools including Harvard, NYU, Duke, Stanford, and UCSF. The majority of students matching into Anesthesiology request Anesthesiology Career Mentors, with 73% (48/66) of students assigned to mentors in the graduating class of 2020 and 2021. 96 mentors were requested in the class of 2020 and 2021, with 29 students (30%) not matching into Anesthesiology. These students may have changed careers and not applied to Anesthesiology. Many of these students choose to pursue other specialties, including Internal Medicine, Radiology, Pediatrics, Family Medicine, General Surgery, Obstetrics-Gynecology, Orthopedic Surgery, and Psychiatry. Some students were not listed in the IUSM Graduation Booklet or did not have a residency listed. Conclusion: Limitations of this analysis include students’ choice to publish their Match data in the IUSM Graduation Booklet and the possibility of some students being lost to follow up due to not graduating yet or changing their name. No direct link can be made between formally assigned Anesthesiology Career Mentors and the Match, especially since some students may have sought out informal mentorship. Anesthesiology continues to be a competitive field with high student interest. More research can be done to understand factors that influence student decisions for specialty and to track student alumni and follow their career progression into fellowship and the physician workforce. Additional data collection on the usefulness of the career mentorship program and ways to improve and further support student career choice and Match success will be especially helpful as Step 1 changes to pass/fail.
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    Cricothyrotomy in Acute Upper Gastrointestinal Bleed: A Difficult Airway Simulation Case for Anesthesiology Residents
    (Association of American Medical Colleges, 2024-01-16) Yu, Corinna J.; Rigueiro, Frank; Backfish-White, Kevin; Cartwright, Johnny; Moore, Christopher; Mitchell, Sally A.; Boyer, Tanna; Anesthesia, School of Medicine
    Introduction: Patients with acute upper gastrointestinal bleeding may have challenging airways. This simulation teaches anesthesiology residents the skill of cricothyrotomy as a surgical last resort while managing acute bleeding in the airway. Methods: The simulation involved a 55-year-old patient with history of alcohol abuse admitted to the ICU with hematemesis and acute blood loss for esophagogastroduodenoscopy in the ICU setting. The mannequin had tubing in the posterior oropharynx connected to a pressurized bag of simulated blood hidden from view. While conversing, the patient began to cough and gag, and the bag of fluid was opened, filling the posterior oropharynx with blood, which prompted immediate intubation attempts, designed to fail no matter what the learners attempted. When residents requested a surgical airway, they were provided with a cricothyrotomy kit and a task trainer to perform the procedure. Residents were evaluated using a behavior checklist, debriefed, then asked to complete a postsimulation survey. Results: Fifty-eight anesthesiology residents completed the simulation and provided feedback via a 5-point Likert scale of agreement. Most residents quickly recognized the need for emergency intubation. Eighty-eight percent of participants strongly agreed that the simulation was a valuable learning experience, with 99% stating it increased their confidence and clinical decision-making in handling similar scenarios in the future. Discussion: This simulation provides a chance to practice valuable airway management skills that increase resident confidence in cricothyrotomy. Future work may examine if these skills and confidence levels are sustainable over time and if they are applied in future patient encounters.
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    A Simulation Case of Cricothyrotomy in an Acute Upper GI Bleed
    (2022-04-28) Yu, Corinna; Rigueiro, Frank; Backfish-White, Kevin; Boyer, Tanna
    Introduction: Although difficult airway management is an expected skill of anesthesiologists, there is no mandatory training focused on this skill set in anesthesiology residency programs. Difficult airways are taught when the clinical situation arises, leading to variable resident expertise. Formal instruction in cricothyrotomy is lacking and the procedure is clinically rare. This lack of training has led to a rise in fellowship programs in airway management, demonstrating the need for greater attention to this skill set. Procedural times for cricothyrotomy improve after educational interventions, providing further evidence to support formal instruction in invasive airway management training. Patients presenting for upper endoscopies are considered full stomach due to the bleeding, and endotracheal intubation is preferred over sedation to prevent aspiration. These airways can be challenging to manage and may require surgical intervention as a last resort. We created a difficult airway simulation scenario to teach residents cricothyrotomy. Objective: To teach anesthesiology residents how to perform a cricothyrotomy and improve their confidence in difficult airway management. Methods: A patient presents with an acute gastrointestinal bleed for an upper endoscopy. A pressurized bag of red fluid was hidden out of view with tubing placed into the SimMan’s posterior oropharynx. Anesthesiology residents obtain the history from the patient when the patient coughs vigorously and its mouth fills with simulated blood. Residents attempt intubation, which is difficult if not impossible on this SimMan. When they communicate their decision for surgical intervention, a secondary mannequin was provided to perform the actual cricothyrotomy. At the end of the simulation, a behavior checklist is used for evaluation and the residents are asked to complete a simulation feedback form. Results: 26 PGY-4 anesthesiology residents completed the simulation from April-May in 2019 with 25 residents providing feedback with a 5-point Likert scale of agreement. Most residents quickly recognized the patient’s need for emergency intubation. 16 residents had prior experience managing the airway in an acute upper GI bleed (average 3 patients) whereas 9 residents reported no prior experience. 88% of participants strongly agreed that the simulation was a valuable learning experience with 92% stating it increased their confidence and clinical decision making in handling similar scenarios in the future. In addition, there were no negative scores to any of the survey questions. Discussion: Difficult airway skills include management of a patient with an upper gastrointestinal bleed requiring surgical cricothyrotomy. This is a valuable skill that can be taught with simulation. Our simulation led to an increase in resident confidence in the procedure, but it would be useful to follow up with the cohort and see if these skills prepared them for patient encounters afterwards and if the learning was sustainable. Conclusion: Our simulation case was a valuable learning experience for residents and provided critical surgical skills for future anesthesiologists in difficult airway management. It is worthwhile to include this simulation in the anesthesiology resident curriculum.
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    Stunned Myocardium as a Sequela of Acute Severe Anemia: An Adult Simulation Case for Anesthesiology Residents
    (Association of American Medical Colleges, 2024-09-06) Okano, David Ryusuke; Ko, Bryan; Giuliano, Marelle; Mitchell, Sally; Cartwright, Johnny; Moore, Christopher; Boyer, Tanna; Anesthesia, School of Medicine
    Introduction: Anesthesiologists develop anesthetic plans according to the surgical procedure, patient's medical history, and physical exams. Patients with ischemic heart disease are predisposed to intraoperative cardiac complications from surgical blood loss. Unanticipated events can lead to intraoperative complications despite careful anesthesia planning. Methods: This anesthetic management simulation was developed for the anesthesiology residency curriculum during the first clinical anesthesia year (CA 1/PGY 2 residents). A total of 23 CA 1 residents participated. A 50-minute encounter focused on a 73-year-old male who presents for an elective total hip replacement and develops acute myocardial stunning in the setting of critical acute blood loss and a delay in the transportation of blood products. Results: One hundred percent of the residents felt the simulation was educationally valuable in the immediate postsimulation survey (Kirkpatrick level 1). The follow-up survey showed that 100% of residents felt the simulation increased their knowledge of managing acute cardiac ischemia (Kirkpatrick level 2), and 93% felt it increased awareness and confidence in similar real-life situations that positively affected patient outcomes (Kirkpatrick level 3). Discussion: Our simulation provides a psychologically safe environment for anesthesiology residents to develop management skills for acute critical anemia and cardiogenic shock and foster communication skills with a surgery team.