Transitioning from 1:1 to 1: 2 Supervision in Anesthesia Training: A Descriptive Survey

Advancement from 1:1 to 1:2 (attending to resident) supervision at the beginning of a CA-1 (clinical anesthesia) year can serve as a model for transition to milestone-based curricula. Currently most programs have an individual mixture of training and advancement criteria formed at the discretion of educational leadership. We designed a questionnaire to evaluate degree of variability at programs nationally.

After obtaining IRB approval, an anonymous survey was sent via Survey Monkey to all Anesthesiology Residency Program Directors with a link for faculty members. The survey remained open for 30 days and two reminders for completion were sent.

Among responses from Program Directors, the following competency areas showed most agreement in being absolutely required for advancement: when to call an attending (78%), preoxygenation (60%), room preparation (81%), monitor placement (81%), machine check (77%), and airway assessment (73%). Responses from faculty identified as most important when to call the attending (82%), basic crisis management while waiting for help (64%), monitor placement (77%), machine check (79%), room preparation(77%), and airway assessment (66%).

There are no clear guidelines for transition from 1:1 to 1:2 supervision with wide variability in the design and requirements for the transition. With only modest agreement among and between Residency Program Directors and faculty members at this clearly defined transition, the challenges of implementation of milestones at every level are significant.