IU Indianapolis ScholarWorks :: Browsing by Subject "anesthesiology"

Browsing by Subject "anesthesiology"

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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.
Effect of Glucose–Insulin–Potassium Infusion on Mortality in Critical Care Settings: A Systematic Review and Meta-Analysis
(2009-07) Puskarich, Michael A; Runyon, Michael S; Trzeciak, Stephen; Kline, Jeffrey A.; Jones, Alan E
This study seeks to measure the treatment effect of glucose—insulin—potassium (GIK) infusion on mortality in critically ill patients. A systematic review of randomized controlled trials is conducted, comparing GIK treatment with standard care or placebo in critically ill adult patients. The primary outcome variable is mortality. Two authors independently extract data and assess study quality. The primary analysis is based on the random effects model to produce pooled odds ratios (ORs) with 95% confidence intervals (CIs). The search yields 1720 potential publications; 23 studies are included in the final analysis, providing a sample of 22 525 patients. The combined results demonstrate no heterogeneity (P = .57, I2 = 0%) and no effect on mortality (OR = 1.02; 95% CI, 0.93–1.11) with GIK treatment. No experimental studies of shock or sepsis populations are identified. This meta-analysis finds that there is no mortality benefit to GIK infusion in critically ill patients; however, study populations are limited to acute myocardial infarction and cardiovascular surgery patients. No studies are identified using GIK in patients with septic shock or other forms of circulatory shock, providing an absence of evidence regarding the effect of GIK as a therapy in patients with shock.
Examining Visiting Student Evaluation Forms
(2023-04-28) Rigueiro, Gabriel; Dammann, Erin; Guillaud, Daniel; Packiasabapathy, Senthil; Mitchell, Sally; Yu, Corinna
Background: Each medical school has clinical evaluation forms with competencies that align with their institutional and course learning objectives. The differences between evaluation forms and the items being assessed presents a challenge for elective course directors to evaluate and complete forms for visiting students. The aim of this project was to compare common characteristics of visiting student evaluation forms presented to an elective course director on Anesthesiology & Perioperative Medicine (APM) in 2022-2023. Materials & Methods: Each medical school has clinical evaluation forms with competencies that align with their institutional and course learning objectives. The differences between evaluation forms and the items being assessed presents a challenge for elective course directors to evaluate and complete forms for visiting students. The aim of this project was to compare common characteristics of visiting student evaluation forms presented to an elective course director on Anesthesiology & Perioperative Medicine (APM) in 2022-2023. Results: Schools (n=33) included ACGME competencies for communication (94%, 31), professionalism (91%, 30), medical knowledge (79%, 26), practice-based improvement (79%, 26), patient care (76%, 25), and systems-based practice (61%, 20) in their evaluation forms. Clinical reasoning skills included history & physical (82%, 27), assessment & plan (79%, 26), differential diagnosis (64%, 21), and charting/note-taking (61%, 20). Additional categories included inter-professionalism (85%, 28), osteopathic principles and practices (64%, 21), self- awareness/receptiveness to feedback (48%, 16), and procedural skills (42%, 14). Formative and summative comments were requested from 94% (31) of schools. Discussion: While many competencies for visiting medical student evaluation forms align with IU School of Medicine evaluations, some subcategories of ACGME core competencies like charting/note-taking are not assessed in the APM elective. Visiting students do not obtain electronic medical record access due to time-prohibitive training requirements, and thus, do not chart during their rotation. Mock paper records for the preanesthetic evaluation history and physical, intraoperative anesthesia record, and postoperative notes and orders could be created as additional assignments to assess students in this skill. Formative/summative comments may or may not comment on the delivery of patient care. Comments frequently discuss teamwork, work ethic, and medical knowledge which are easily evaluated. The time-pressured environment of the OR can limit student opportunity to perform the preoperative anesthetic evaluation. A differential diagnosis during a preoperative history and physical is challenging on the APM elective because patients present to surgery after diagnostic workup. However, differential diagnoses for perioperative symptoms like tachycardia and hypertension could be assessed through Canvas case log discussions. Students currently share an abbreviated written patient presentation with a learning point. They could include perioperative differential diagnoses and treatment plans and share an article from the literature to demonstrate evidence-based learning with more specific questions about systems-based practice. The perioperative environment provides an excellent opportunity to evaluate students in their interprofessional and communication skills working with surgeons, nurses, technicians, assistants, and other learners. Additional questions could be included in the APM evaluation to capture these relationships more fully. Conclusion: Analyzing visiting student evaluations for competencies and skills provides insight into areas for improvement in the APM elective curriculum and clinical evaluation form.
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.
Unanticipated Difficult Intubation In An Adult Patient
(StatPearls Publishing, 2022) Traylor, Beth Ann; McCutchan, Amy; Anesthesia, School of Medicine

Browsing by Subject "anesthesiology"

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