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Browsing by Author "Rigueiro, Frank"
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Item A Simulation Case of Cricothyrotomy in an Acute Upper GI Bleed(2022-09-17) Yu, Corinna J.; Rigueiro, Frank; Backfish-White, Kevin; Boyer, Tanna J.Item 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 MedicineIntroduction: 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.Item Parental Leave During Anesthesiology Fellowship(2022-04-28) Rigueiro, Frank; Yu, CorinnaIntroduction: Parental leave is an important consideration for many residents and fellows as they choose programs balancing their career goals with their goals for family planning. Benefits of parental leave are decreased infant mortality and increased breastfeeding, which has health benefits for infants and mothers. In 2018, one study found only 7 of 15 residency training institutions in the local area had an institutional GME policy providing paid designated childbearing leave. A study at Mayo Clinic at 269 programs found that 40% of residents and fellows planned to have children during training. 89% of fathers rated parental leave as an important benefit, and pregnancy and childbirth plans altered choice of GME program in women more often than in men. The ACGME encourages allowances for parental leave but does not provide specific recommendations on how to manage the leave, giving programs institutional control over their own policy. Leave policies can be complicated by requirements from Centers for Medicare and Medicaid Services, Health Resources and Services Administration, the Veterans Health Administration, and the National Institutes of Health, depending on allocations for resident/fellow salary. Objective: As prospective anesthesiology fellows research programs with family planning in mind, how accessible are these local GME policies on parental leave? Methods: We compiled a list of all 140 ACGME-approved anesthesiology fellowship programs including 60 pediatric, 74 adult cardiothoracic, 63 critical care, 39 regional and acute pain medicine, 41 obstetric, 111 chronic pain medicine & 1 clinical informatic program. We performed online searches of each program’s website to look for institutional GME policies on parental leave. If we could not find the results within 10 minutes, it was considered not easily accessible. Results: Out of 140 anesthesiology ACGME-approved fellowship programs, 99 programs had parental leave policies easily accessible online (71%) whereas 41 programs did not have policies easily accessible online (29%). Of these 41 programs, 6 of them required a log-in for access to their parental leave policies. Discussion: Anesthesiology fellowship programs should consider having a generous parental leave policy and making this policy easily accessible online to demonstrate support for physician well-being and work-life balance. We found that many anesthesiology fellowship programs do not have parental leave policies easily accessible online for interested applicants. Reasons many trainees don’t use parental leave include the sense of being a burden to colleagues, anticipation of a heavier workload later, delayed program completion, not needing the time, or not being the primary caregiver. Additional research should pursue opportunities for competency-based training, flexible scheduling of work hours or start dates, part-time options, and childcare benefits to meet the rising demands of the current workforce. Conclusion: Parental leave is an important public health priority and an important aspect to physician well-being. Residency and fellowship programs should ensure they have established institutional GME policies and share them publicly in an easily accessible format online with interested applicants to remain competitive and guarantee a diverse applicant pool.Item Parental Leave During Anesthesiology Fellowship(2022-09-17) Rigueiro, Frank; Yu, Corinna J.Item A Simulation Case of Cricothyrotomy in an Acute Upper GI Bleed(2022-04-28) Yu, Corinna; Rigueiro, Frank; Backfish-White, Kevin; Boyer, TannaIntroduction: 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.