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Related Concept Videos

General Anesthesia: Overview01:24

General Anesthesia: Overview

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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
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Stages of General Anesthesia01:22

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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Anesthesiology Milestones 1.0: Residents' Learning Trajectories and Training Outcomes.

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Straight-lining in anesthesiology Milestones evaluations is common, raising concerns about accurate resident performance assessment. Programs significantly influence resident ratings and growth, highlighting the need for standardized evaluations.

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Area of Science:

  • Medical Education Research
  • Anesthesiology Training
  • Competency-Based Assessment

Background:

  • Anesthesiology programs must submit semi-annual Milestones ratings per ACGME requirements.
  • This study investigates anesthesiology resident progress through Milestones evaluations.

Purpose of the Study:

  • To assess the prevalence of straight-lining in Anesthesiology Milestones 1.0 ratings.
  • To describe resident progression trajectories and graduation outcomes.
  • To examine factors influencing resident growth using statistical models.

Main Methods:

  • Analyzed Milestones data from 11,691 residents across 153 anesthesiology programs (July 2015-June 2019).
  • Assessed straight-lining prevalence and resident progression.
  • Employed 3-level linear mixed-effect models to analyze growth and program variability.

Main Results:

  • High prevalence of straight-lining (88.9% of programs).
  • Most residents (98.3%) achieved Level 4 by graduation, but 28.8%-36.8% had deficiencies in at least one subcompetency.
  • Residency programs explained 63%-84% of baseline rating variability and 60%-92% of growth rate variability.

Conclusions:

  • Straight-lining in Milestones ratings may compromise accurate individual performance assessment.
  • Program-level factors significantly impact resident performance variability.
  • Standardization of Milestones evaluations is crucial for reliable progress tracking and targeted improvement.