Browsing by Author "Mitchell, Sally A."

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    Career Mentors & 5-Year Data on the IUSM Anesthesiology Match
    (2022-09-17) Yu, Corinna J.; Ye, Jian; Boyer, Tanna J.; Mitchell, Sally A.
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    A Comparison of Favored Learning Modalities
    (2020-09-12) Priddy, Connor; Dahl, John P.; Mitchell, Sally A.; Boyer, Tanna J.
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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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    Development of a Hybrid Clinical & Academic Anesthesiology Elective
    (2021-09-18) Yu, Corinna; Guillaud, Daniel; Webb, Timothy; Sanborn, Belinda; Cartwright, Johnny F.; Mitchell, Sally A.
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    Development of a simulation technical competence curriculum for medical simulation fellows
    (BMC, 2022-08-09) Ahmed, Rami A.; Cooper, Dylan; Mays, Chassity L.; Weidman, Chris M.; Poore, Julie A.; Bona, Anna M.; Falvo, Lauren E.; Moore, Malia J.; Mitchell, Sally A.; Boyer, Tanna J.; Atkinson, S. Scott; Cartwright, Johnny F.; Emergency Medicine, School of Medicine
    Background and needs: Medical educators with simulation fellowship training have a unique skill set. Simulation fellowship graduates have the ability to handle basic and common troubleshooting issues with simulation software, hardware, and equipment setup. Outside of formal training programs such as this, simulation skills are inconsistently taught and organically learned. This is important to address because there are high expectations of medical educators who complete simulation fellowships. To fill the gap, we offer one way of teaching and assessing simulation technical skills within a fellowship curriculum and reflect on lessons learned throughout the process. This report describes the instructional designs, implementation, and program evaluation of an educational intervention: a simulation technology curriculum for simulation fellows. Curriculum design: The current iteration of the simulation technical skill curriculum was introduced in 2018 and took approximately 8 months to develop under the guidance of expert simulation technology specialists, simulation fellowship-trained faculty, and simulation center administrators. Kern's six steps to curriculum development was used as the guiding conceptual framework. The curriculum was categorized into four domains, which emerged from the outcome of a qualitative needs assessment. Instructional sessions occurred on 5 days spanning a 2-week block. The final session concluded with summative testing. Program evaluation: Fellows were administered summative objective structured exams at three stations. The performance was rated by instructors using station-specific checklists. Scores approached 100% accuracy/completion for all stations. Conclusions: The development of an evidence-based educational intervention, a simulation technical skill curriculum, was highly regarded by participants and demonstrated effective training of the simulation fellows. This curriculum serves as a template for other simulationists to implement formal training in simulation technical skills.
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    Innovative Use of High-Fidelity Lung Simulators to Test a Ventilator Splitter Device
    (Wolters Kluwer, 2020-06-02) Boyer, Tanna J.; Mitchell, Sally A.; Cartwright, Johnny F.; Ahmed, Rami A.; Anesthesia, School of Medicine
    The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider creative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simulators included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.
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    Innovative Use of High-Fidelity Lung Simulators to Test a Ventilator Splitter Device
    (Wolters Kluwer, 2020-06-02) Boyer, Tanna J.; Mitchell, Sally A.; Cartwright, Johnny F.; Ahmed, Rami A.; Anesthesia, School of Medicine
    The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider cre-ative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simula-tors included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.
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    Interdisciplinary Surgery-Anesthesia Education as a Valuable Component of Surgical Pre-Internship Training
    (2022-09-17) Xu, Karen K.; Stanton-Maxey, Katie J.; Mitchell, Sally A.; Yu, Corinna J.; Dunlap, Julie D.; Boyer, Tanna J.
    Background/Objective: Research has shown that skills-based workshops for medical students entering a surgical internship can improve learner self-confidence and provide opportunities for competency assessment.1,2 The ACS/APDS/ASE Resident Prep Curriculum is used nationally to prepare medical students for entrance into a surgical internship. This curriculum includes workshops traditionally taught by surgical faculty, teaching emergency procedures such as cricothyroidotomy without first-line airway interventions.3 We propose widespread adoption of an interdisciplinary airway and line workshop taught by anesthesia faculty as an educational intervention for pre-internship surgeons. Interdisciplinary medical education has been shown to improve perceptions of interdisciplinary collegiality and attitudes.4 This is the first known addition of anesthesiologists as teaching faculty in workshops designed to prepare medical students for a surgical internship. Methods: A half-day workshop for medical students entering surgical internships was designed as part of the MS4 preparation for internship rotation at IUSM beginning in Spring of 2017. The workshop consists of four stations and two discussions, all taught by anesthesia faculty. Prior to the workshop, learners receive access to presentations and videos for each procedure via an online learning management system (Canvas). The day begins with a discussion of difficult airway characteristics and facial morphologies that may necessitate an airway discussion prior to anesthesia. Learners then begin rotating through a total of four stations. Skills taught at these stations include IV and arterial line placement with and without ultrasound, basic airway management skills, management of difficult airways, and emergency airway access. Learners also complete a simulation exercise covering noninvasive respiratory support options in a patient with increasing respiratory distress. At the end of the workshop, learners participate in a debriefing session and discussion of how to avoid future anesthesia cancellations. They also complete a post-workshop evaluation before leaving. Results: The post-workshop evaluation was completed by 20 students in 2019 and 23 students in 2022. All learners agreed or strongly agreed that faculty from non-surgical specialties had important knowledge and wisdom for surgical trainees. Nearly all learners agreed or strongly agreed that the workshop was useful (41/43, 95%), boosted their clinical self-confidence in airway management (39/43, 91%), and that the skills and knowledge learned would be useful to them as interns and residents (42/43, 98%). Most learners (39/43, 91%) agreed or strongly agreed that this workshop should be mandatory for all students preparing for a surgical internship. Conclusions: This interdisciplinary surgery-anesthesia workshop was valuable to learners. The success of this workshop highlights the role of anesthesia providers in interdisciplinary education to prepare medical students for a surgical internship. We also highlight the worthiness of anesthesia faculty time in the education of future surgical colleagues; discussions on when to consult anesthesia for difficult airways and other issues may improve collegiality and camaraderie between disciplines and decrease same-day surgery cancellations. References: 1. Peyre SE, Peyre CG, Sullivan ME, Towfigh S. A surgical skills elective can improve student confidence prior to internship. J Surg Res. 2006;133(1):11-15. doi:10.1016/j.jss.2006.02.022 2. Brunt LM, Halpin VJ, Klingensmith ME, et al. Accelerated skills preparation and assessment for senior medical students entering surgical internship. J Am Coll Surg. 2008;206(5):897-907. doi:10.1016/j.jamcollsurg.2007.12.018 3. ACS/APDS/ASE Resident Prep Curriculum. ACS. https://www.facs.org/for-medical-professionals/education/programs/acs-apds-ase-resident-prep-curriculum/. Accessed June 13, 2022. 4. Bullard MJ, Fox SM, Wares CM, Heffner AC, Stephens C, Rossi L. Simulation-based interdisciplinary education improves intern attitudes and outlook toward colleagues in other disciplines. BMC Med Educ. 2019;19(1):276. Published 2019 Jul 24. doi:10.1186/s12909-019-1700-1
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    Intraoperative Accidental Extubation During Thyroidectomy in a Known Difficult Airway Patient: An Adult Simulation Case for Anesthesia Residents
    (2022-09-17) Perez Toledo, Javier A.; Okano, David R.; Mitchell, Sally A.; Cartwright, Johnny F.; Moore, Christopher; Boyer, Tanna J.
    Background: Intraoperative accidental extubation on a known difficult airway patient requires prompt attention. The incidence of accidental extubation is not very well known for the OR setting, however studies conducted in the ICU have ranges that vary widely from 0.5 to 35.8% in adults and even more so in the neonatal population with a range of 1% to 80.8%.[1-4] The accidental removal of an ETT can lead to injury of the vocal cords if the tracheal cube is still inflated. If the patient has a large amount of secretions it can lead to aspiration and ultimately aspiration pneumonia. If gone unnoticed it can lead to inadequate ventilation leading to hypoxemia and potential hypotension, brain damage, cardiac arrest, and death.[5-7] A good understanding of the steps to re-establish the airway is critical especially when the patient is known as a difficult airway. In regard to difficult airways, the incidence of different factors varies, for example the incidence of a difficult oro-tracheal intubation is around 7.4% [8] while the incidence of a difficult mask ventilation is 7.8%.[9] The situation becomes even more complicated if the case has been taken over by another anesthesiologist during the surgery, and specific and detailed information may not have been conveyed.[10] Methods: This scenario is a staple in our simulation curriculum, placed later in the CA-1/PGY-2 year. It is performed with a high-fidelity mannikin, with simulation environment set up as a true operating room. This simulation is primarily designed to train first-year clinical anesthesia (CA-1, PGY-2) residents. It is designed as a 50-minute encounter and focuses on the management of unintentional loss of an airway during a thyroidectomy on a known difficult airway patient. The endotracheal tube dislodgement is simulated by deliberate tube manipulation through the cervical access window of the mannequin. Following the conclusion of the simulation, residents learn via debriefing with good intention where they discuss learning objectives and receive formative feedback Results: Residents are given formative feedback and ungraded. The majority of the resident participants met the designed educational objectives. The learners were asked to provide feedback of their experience in the form of an online survey and 17/25 (68%) residents responded. Discussion: This simulation scenario achieves the educational objective of development of intraoperative emergency airway management skills for anesthesia residents. With simulation, we can accomplish this in a psychologically safe environment with no harm to actual patients. This simulation is also able to foster communication skills among anesthesiologists and the surgery team. Time constraints limit the number of residents who can sit in the "hot seat" but all participants learned from the scenario. Our feedback shows the airway structure of the mannequin limits the adequate insertion and positioning of supraglottic airway devices.  Sources: 1. da Silva PS, Fonseca MC. Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg. 2012 May;114(5):1003-14.. https://doi.org/10.1213/ANE.0b013e31824b0296 2. da Silva PS, de Carvalho WB. Unplanned extubation in pediatric critically ill patients: a systematic review and best practice recommendations. Pediatr Crit Care Med. 2010;11:287–294. https://doi.org/10.1097/PCC.0b013e3181b80951 3. Kapadia FN, Bajan KB, Raje KV. Airway accidents in intubated intensive care unit patients: an epidemiological study. Crit Care Med. 2000;28:659–664. https://doi.org/10.1097/00003246-200003000-00010 4. McNett M, Kerber K. Unplanned Extubations in the ICU: risk factors and strategies for reducing adverse events. J Clin Outcomes Manag. 2015;22:303–311. 5. Chao CM, Sung MI, Cheng KC, Lai CC, Chan KS, Cheng AC, Hsing SC, Chen CM. Prognostic factors and outcomes of unplanned extubation. Sci Rep. 2017 Aug 17;7(1):8636. https://doi.org/10.1038/s41598-017-08867-1 6. de Lassence A, Alberti C, Azoulay É, et al. Impact of unplanned extubation and reintubation after weaning on nosocomial pneu-monia risk in the intensive care unit. A prospective multicenter study. Anesthesiology. 2002;97(1):148-156 https://doi.org/10.1097/00000542-200207000-00021 7. Kapadia F. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med. 2001; 163(7): 1755-1756 https://doi.org/10.1164/ajrccm.161.6.9908068 8. Combes X, Jabre P, Jbeili C, Leroux B, Bastuji-Garin S, Margenet A, Adnet F, Dhonneur G. Prehospital standardization of medical airway management: incidence and risk factors of difficult airway. Acad Emerg Med. 2006 Aug;13(8):828-34. https://doi.org/10.1197/j.aem.2006.02.016 9. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth. 2005;19(1):7-11. doi: 10.1007/s00540-004-0275-z. PMID: 15674508. https://doi.org/10.1007/s00540-004-0275-z 10. Solet, Darrell J., et al. "Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs." Academic Medicine 80.12 (2005): 1094-1099.
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    Intraoperative Accidental Extubation during Thyroidectomy in a Known Difficult-Airway Patient: An Adult Simulation Case for Anesthesiology Residents
    (MDPI, 2022-10-12) Okano, David R.; Perez Toledo, Javier A.; Mitchell, Sally A.; Cartwright, Johnny F.; Moore, Christopher; Boyer, Tanna J.; Anesthesia, School of Medicine
    Intraoperative accidental extubation on a known difficult-airway patient requires prompt attention. A good understanding of the steps to re-establish the airway is critical, especially when the patient is known to have a difficult airway documented or discovered on induction or acquires a difficult airway secondary to intraoperative events. The situation becomes even more complicated if the case has been handed off to another anesthesiologist, where specific and detailed information may not have been conveyed. This simulation was designed to train first-year clinical anesthesia residents. It was a 50 min encounter that focused on the management of complete loss of an airway during a thyroidectomy on a known difficult-airway patient. The endotracheal tube dislodgement was simulated by deliberate tube manipulation through the cervical access window of the mannequin. Learners received a formative assessment of their performance during the debrief, and most of the residents met the educational objectives. Learners were asked to complete a survey of their experience, and the feedback was positive and constructive. The response rate was 68% (17/25). Our simulation program helped anesthesiology residents develop intraoperative emergency airway management skills in a safe environment, as well as foster communication skills among anesthesiologists and the surgery team.