Educating Anesthesiologists During the Coronavirus Disease 2019 Pandemic and Beyond

Effects of flipped classroom teaching in anaesthesiology residents: a protocol for systematic review and meta-analysis

INTRODUCTION

The flipped classroom teaching model is widely used in medical education and is indicated to be better than traditional lecture approaches in many medical specialties. Emerging studies have evaluated the effects of the flipped classroom teaching model on anaesthesiology residents. This protocol aims to perform a systematic review and meta-analysis to determine whether the flipped classroom teaching model is superior to traditional teaching methods for anaesthesiology residents.

METHODS AND ANALYSIS

Seven databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure, Wanfang Data and the VIP database, will be systematically searched from their inception to 1 June 2024. Randomised controlled trials that compared the effects of flipped classrooms versus traditional teaching methods in anaesthesiology residents will be included. The primary outcome will be the theoretical knowledge score. The secondary outcomes will include skill scores and the proportion of anaesthesiology residents who preferred the flipped classroom model. RevMan V.5.4 software will be used to perform the statistical analysis. The Grading of Recommendation, Assessment, Development and Evaluation approach will assess the quality of evidence.

ETHICS AND DISSEMINATION

Ethical approval is not applicable to this protocol. The results of this study will be submitted to a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42024497935.

Ventilator Training through International Telesimulation in Sierra Leone

Background

The coronavirus disease (COVID-19) pandemic resulted in an increased need for medical professionals with expertise in managing patients with acute hypoxemic respiratory failure, overwhelming the existing critical care workforce in many low-resource countries.

Objective

To address this need in Sierra Leone, we developed, piloted, and evaluated a synchronous simulation-based tele-education workshop for healthcare providers on the fundamental principles of intensive care unit (ICU) management of the COVID-19 patient in a low-resource setting.

Methods

Thirteen 2-day virtual workshops were implemented between April and July 2020 with frontline Sierra Leone physicians and nurses for potential ICU patients in hospitals throughout Sierra Leone. Although all training sessions took place at the 34 Military Hospital (a national COVID-19 center) in Freetown, participants were drawn from hospitals in each of the provinces of Sierra Leone. The workshops included synchronous tele-education-directed medical simulation didactic sessions about COVID-19, hypoxemia management, and hands-on simulation training about mechanical ventilation. Measures included pre and postworkshop knowledge tests, simulation checklists, and a posttest survey. Test results were analyzed with a paired sample t test; Likert-scale survey responses were reported using descriptive statistics; and open-ended responses were analyzed using thematic analysis.

Results

Seventy-five participants enrolled in the program. On average, participants showed 20.8% improvement (a score difference of 4.00 out of a maximum total score of 20) in scores between pre and postworkshop knowledge tests (P = 0.004). Participants reported satisfaction with training (96%; n = 73), achieved 100% of simulation checklist objectives, and increased confidence with ventilator skills (96%; n = 73). Themes from the participants' feedback included increased readiness to train colleagues on critical care ventilators at their hospitals, the need for longer and more frequent training, and a need to have access to critical care ventilators at their hospitals.

Conclusion

This synchronous tele-education-directed medical simulation workshop implemented through partnerships between U.S. physicians and Sierra Leone healthcare providers was a feasible, acceptable, and effective means of providing training about COVID-19, hypoxemia management, and mechanical ventilation. Future ICU ventilator training opportunities may consider increasing the length of training beyond 2 days to allow more time for the hands-on simulation scenarios using the ICU ventilator and assessing knowledge application in long-term follow-up.

Medical education environment perception and learning engagement in undergraduate nursing students: The mediating effect of self-regulated learning ability

AIM

To investigate the interrelationships of medical education environment perception, learning engagement and self-regulated learning ability among Chinese undergraduate nursing students.

BACKGROUND

After the outbreak of COVID-19, great changes have taken place in the medical education environment, many offline teaching and academic activities have been replaced by online activities. Students' learning engagement influences the efficiency of online learning. However, the mediating effect of self-regulated learning (SRL) ability between medical education environment perception and learning engagement is unclear.

DESIGN

This study involved a cross-sectional descriptive correlational research.

METHODS

A total of 228 undergraduatenursing students who were attending online learning were included in this study.This investigation adopted Dundee Ready Educational Environment Measure scale (DREEM), Motivated Strategies for Learning Questionnaire (MSLQ) and Utrecht Work Engagement Scale-Student scale (UWES-S) to respectively know about the levels of medical education environment perception, self-regulating and learning engagement. The structural equation model and bootstrap method were used to clarify the association and interaction among the three variables.

RESULTS

The scores of nursing students' medical education environment perception, SRL ability and learning engagement were 135.64 ± 15.12, 161.39 ± 22.57 and 68.01 ± 11.77, respectively. Perception of medical education environment directly affects learning engagement (β = 0.556, P < 0.001). SRL ability partially mediated the effect of medical environment perception on learning engagement (x2/df = 1.427, RMSEA = 0.043, GFI = 0.962, NFI = 0.954, TLI = 0.980, CFI = 0.986), and the variance was 30.8 %.

CONCLUSION

SRL ability plays a mediating role between medical education environment perception and learning engagement. Nursing educators should continuously optimize the online education environment, such as designing intelligent teaching platform or software, adopting interactive teaching methods, strengthening professional value education and encouraging peer learning, so as to meet the requirements of nursing students' learning engagement in the new medical education environment.

Development and Implementation of Video-Recorded Simulation Scenarios to Facilitate Case-Based Learning Discussions for Medical Students' Virtual Anesthesiology Clerkship

INTRODUCTION

The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible.

METHODS

We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum.

RESULTS

Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning.

DISCUSSION

We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula.

A Multi-Site Survey Study on the Association Between the COVID-19 Pandemic and United States Anesthesiology Residents' Mental Health

BACKGROUND

 At the onset of the coronavirus disease 2019 (COVID-19) pandemic, anesthesiology residency programs were impacted differently due to various factors such as the local severity of COVID-19, exposure to patient suffering, and inability to complete rotations. We sought to investigate the impact of local-level pandemic severity on the well-being of anesthesiology residents.

METHODS

 This multi-site study surveyed postgraduate year two residents from 15 United States (US) anesthesiology programs using the Perceived Stress Scale, Mini-Z, Patient Health Questionnaire-9,WHO-5 Well-Being Index,and the Multidimensional Scale of Perceived Social Support before the pandemic (baseline survey) and during the first COVID-19 surge (post survey).

RESULTS

 A total of 144 (65%) residents responded to the initial baseline survey; 73 (33%) responded to the post survey, and 49 (22%) completed both surveys. There was not a statistically significant difference in any well-being outcomes of participants between the surveys, nor was there a significant difference based on the severity of COVID-19 impact at the program's hospital. Male participants had higher perceived stress scores (β = 4.05, 95%CI: 0.42, 7.67, P = 0.03) and lower social support from family (β = -6.57, 95%CI: -11.64, -1.51, P = 0.01) at the post survey compared to female participants after controlling for baseline scores. Additionally, married participants or those with domestic partners reported higher perceived social support in the post survey (β = 5.79, 95%CI: -0.65, 12.23, P = 0.03).

CONCLUSION

 The local COVID-19 severity at a residency program did not disproportionately impact well-being scores among anesthesiology residents. Those most vulnerable to diminished well-being appeared to be male and single participants. As a result, targeted well-being interventions, including those aiming to increase social support, to higher-risk resident groups may be indicated. Future work is needed to assess the longstanding COVID-19 pandemic impacts on resident well-being.

The Impact of COVID-19 on the Training of Anesthesiologists in Hong Kong: Overcoming the Challenge

Objectives

This study aimed to investigate the impact of COVID-19 on the training of anesthesiologists in Hong Kong.

Introduction

COVID-19 has caused a substantial impact on anesthesiology training in multiple domains. The challenges faced by both trainees and educators remain a significant concern and adaptations in clinical teaching are warranted. We conducted this study to quantify the impact and identify learning areas in recurring pandemics.

Methods

Electronic surveys were distributed to anesthesiology trainees and fellows in Hospital Authority in Hong Kong. Data from respondents were collated and analyzed. Reliability analysis and exploratory factor analysis (EFA) were performed.

Results

A total of 97 responses were collected and analyzed. Majority (59% of trainees and 79% of fellows) agreed that the COVID-19 pandemic negatively impacted anesthesia training overall. Bag-mask ventilation and direct laryngoscopy were the 2 most affected areas in airway training; 47% of fellows observed a technical skill decline among trainees. Most respondents (64% of trainees and 71% of fellows) agreed that simulation sessions could help with residents' training. Exploratory factor analysis indicated the following subscales: loss of educational opportunities, loss of caseload and formal training, loss of technical skills (regional and procedural), loss of technical skills (airway management), the hampering of ICU rotations, and difficulty teaching residents.

Conclusion

The COVID-19 pandemic has caused disruptions in caseload, technical skills training, work-based assessment, and continued medical education, hampering both trainees' and fellows' education. Measures to counter the effect of the pandemic were discussed. Our findings will help educators better understand the challenges, marshal resources, and plan to enhance trainees' educational experience.

The Feasibility and Effectiveness of an Online Curriculum for Virtual Onboarding/Orientation of Graduate Medical Education Learners During the COVID-19 Pandemic

Background

Graduate medical education (GME) orientation/onboarding is conventionally an in-person activity, but the COVID-19 pandemic prompted virtual approaches to learner onboarding. However, online GME onboarding strategies have not been disseminated in the literature.

Objective

To determine the usefulness of an online curriculum for GME learner orientation at a large sponsoring institution using an electronic survey. The primary outcome was to discover the usefulness of our online curriculum for GME onboarding, and secondary outcomes included identifying barriers to implementation and weaknesses associated with online GME orientation.

Methods

We created an online GME orientation curriculum to onboard incoming learners (from June 1 to August 31, 2020) and electronically surveyed our learners to determine the usefulness of this novel approach. We conducted orientation sessions and electronically recorded questionnaire responses using CarmenCanvas, our institutional learning management system. Linear regression analysis was performed to identify factors predicting satisfaction with virtual GME orientation using IBM SPSS Statistics, Version 26.0 (Armonk, NY, USA).

Results

Of 353 trainees, 272 completed the survey for a 77% response rate. 97% of respondents reported that the curriculum supported performance of learner duties. 79% of trainees perceived the overall quality as "very good" or "good", 91% responded that the curriculum provided "effective learning", 94% reported "accessing the course content easily", 92% reported "easily navigating the curriculum", 91% described the curriculum as "well-organized", and 87% reported that the lectures "supported their learning".

Conclusion

Online delivery of a comprehensive GME orientation curriculum is useful and facilitates learner education, training, and integration into a large GME institution in the COVID-19 era.

Practice what you teach: An approach to integrate airway education for experienced anesthesia clinicians

BACKGROUND

The COVID-19 pandemic has disrupted clinician education. To address this challenge, our divisional difficult airway program (AirEquip) designed and implemented small-group educational workshops for experienced clinicians. Our primary aim was to test the feasibility and acceptability of a small-group, flexible-curriculum skills workshop conducted during the clinical workday. Secondary objectives were to evaluate whether our workshop increased confidence in performing relevant skills and to assess the work-effort required for the new program.

METHODS

We implemented a 1:1 and 2:1 (participant to facilitator ratio) airway skills workshop for experienced clinicians during the workday. A member of the AirEquip team temporarily relieved the attendee of clinical duties to facilitate participation. Attendance was encouraged but not required. Feasibility was assessed by clinician attendance, and acceptability was assessed using three Likert scale questions and derived from free-response feedback. Participants completed pre and postworkshop surveys to assess familiarity and comfort with various aspects of airway management. A work-effort analysis was conducted and compared to the effort to run a previously held larger-format difficult airway conference.

RESULTS

Fifteen workshops were conducted over 7 weeks; members of AirEquip were able to temporarily assume participants' clinical duties. Forty-seven attending anesthesiologists and 17 CRNAs attended the workshops, compared with six attending anesthesiologists and five CRNAs who attended the most recent larger-format conference. There was no change in confidence after workshop participation, but participants overwhelmingly expressed enthusiasm and satisfaction with the workshops. The number of facilitator person-hours required to operate the workshops (105 h) was similar to that required to run a single all-day larger-format conference (104.5 h).

CONCLUSION

It is feasible and acceptable to incorporate expert-led skills training into the clinical workday. Alongside conferences and large-format instruction, this modality enhances the way we are able to share knowledge with our colleagues. This concept can likely be applied to other skills in various clinical settings.

Virtual Compared to In-Person Obstetric Anesthesiology Trainee Education During the COVID-19 Pandemic: A Short Report

Background: The COVID-19 pandemic brought many changes to medical training, including in-person education platforms being disbanded and replaced with virtual education. At our institution, dedicated obstetric anesthesiology teaching for residents and fellows occurs daily and is highly valued and rated. In March 2020 due to the COVID-19 pandemic, we changed the teaching platform from in-person to virtual teaching (via video communication). We subsequently surveyed residents, fellows, and attendings to determine the impact of virtual compared with in-person teaching.

Methods: To assess the impact of this change, an electronic survey was sent to 10 anesthesiology residents on their 2nd obstetric anesthesiology rotation, and 10 residents on their 1st rotation, respectively. The electronic survey was also sent to three fellows and eight obstetric anesthesiology attendings. Answers were based on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

Results: The results for 1st rotation residents were higher in all domains compared with 2nd rotation residents and fellows, where “quality” achieved statistical significance (p=0.009) between 1st and 2nd rotation residents. “Engagement” was overall the most impacted domain for trainees. Attendings did not feel that virtual teaching impacted their ability to provide adequate education, however, learner engagement was again the lowest rated domain, and teachers strongly favored resuming in-person teaching.

Conclusions:Virtual teaching is an appropriate alternative when in-person teaching is not possible. Future initiatives are needed to improve engagement and better facilitate virtual teaching.

Flipped classrooms in higher education during the COVID-19 pandemic: findings and future research recommendations

Flipped classroom (FC) approaches have gotten substantial attention in the last decade because they have a potential to stimulate student engagement as well as active and collaborative learning. The FC is generally defined as a strategy that flips the traditional education setting, i.e., the information transmission component of a traditional face-to-face lecture is moved out of class time. The FC relies on technology and is therefore suitable for online or blended learning, which were predominant forms of learning during the COVID-19 pandemic (March 2020-July 2021). In this paper we present a systematic literature review (SLR) of studies that covered online FC approaches in higher education during the pandemic. We analyzed 205 publications in total and 18 in detail. Our research questions were related to the main findings about the success of implementation of online FC and recommendations for future research. The findings indicated that those who had used FC approaches in face-to-face or blended learning environments more successfully continued to use them in online environments than those who had not used it before. The SLR opened possible questions for future research, such as the effectiveness of the FC for different courses and contexts, the cognitive and emotional aspects of student engagement, and students' data protection. It pointed to the need to examine different aspects of online delivery of the FC more comprehensively, and with more research rigor.

Newer teaching-learning methods and assessment modules in anaesthesia education

The National Medical Commission in its recent guidelines has stated that postgraduate training in anaesthesiology should have clear objectives and be competency based. This means that the existing teaching–learning (TL) methods need a major face-lift. E-learning and blended learning including learning management systems, virtual classrooms, app-based learning, flipped classroom, podcasts, webinars, web-based collaborative education, reflective feedback, problem-based discussions and mentorship are some newer TL methods that can be adopted. Simulation can help teach technical and non-technical skills such as leadership, teamwork and communication. In line with TL methods, newer assessment methods have to be applied to revolutionise postgraduate anaesthesia education. Formative assessment and assessment of clinical skills are important and to do this, workplace-based assessment methods such as mini-clinical evaluation exercise, direct observation of procedural skills, multisource feedback, logbook and E-portfolio can be applied. Objective structured clinical examination, simulation-based assessment and E-assessment are other useful evaluation methods.

Nitrous Oxide Sedation Asynchronous Curriculum for Pediatric Emergency Medicine Providers

This technical report describes a nitrous oxide sedation training curriculum for pediatric emergency medicine providers. This curriculum was used during the novel coronavirus disease 2019 (COVID-19) pandemic where in-person classroom training was significantly limited. We demonstrate a model for concept and equipment learning with video-guided self-practice in place of in-person training with a facilitator. A similar model can be utilized for other equipment or concept training.

Graduate medical education in anaesthesiology and COVID-19: lessons learned from a global pandemic

PURPOSE OF REVIEW

The recent global pandemic has dramatically altered the anaesthesiology educational landscape in unexpected ways. It is important that we pause to learn from this crisis.

RECENT FINDINGS

Most resident trainees actively caring for COVID-19 patients present with probable or subclinical finding of post-traumatic stress disorder. Anaesthesia resident training programmes evolved to continue the mission of anaesthesia education in the face of institutional restrictions and evolving clinical crises.

SUMMARY

The recent global COVID-19 pandemic has illustrated how external stressors can cause significant disruption to traditional medical education pathways. Resilience to external disruptive forces in anaesthesia education include a willingness of leadership to understand the problem, flexibility in adapting to the needs of learners and instructors in the face of key challenges, deployment of technology and innovation-minded solution-finding where appropriate, and attention to Maslow's hierarchy of needs.

VIDEO ABSTRACT

http://links.lww.com/COAN/A77.

[COVID-19: a chance for digitalization of teaching? : Report of experiences and results of a survey on digitalized teaching in the fields of anesthesiology, intensive care, emergency, pain and palliative medicine at the University of Leipzig]

Hintergrund

Die SARS-CoV-2-Pandemie hat die Universitäten vor große Herausforderungen gestellt. Innerhalb kürzester Zeit galt es, Lehrveranstaltungen zu digitalisieren. Dies betraf auch den Bereich Anästhesiologie, Intensiv‑, Notfall‑, Schmerz- und Palliativmedizin an der Universität Leipzig.

Fragestellung

Ziel der fragebogengestützten Untersuchung war es herauszufinden, welche Veranstaltungen aus Sicht der Studierenden am ehesten digitalisiert werden können, und welche technische Infrastruktur die Lehrenden bei der Digitalisierung jeweils bestmöglich unterstützt.

Material und Methoden

Für die digitale Durchführung der Lehrveranstaltungen wurden Videopodcasts, digitale Lernmaterialien, Lehrfilme und Videokonferenzen genutzt. Je nach Veranstaltung wurden verschiedene dieser Angebote kombiniert. Darüber hinaus wurde ein Diskussionsforum für den Austausch zwischen Lehrenden und Studierenden etabliert. Zur Bewertung der Inhalte erfolgte im Anschluss eine Onlineevaluation.

Ergebnisse

An der Befragung haben 82 Studierende teilgenommen. Als effektivste Angebote zur Wissensvermittlung wurden die Videopodcasts der Vorlesung (45,1 %) sowie der elektronische Unterricht am Krankenbett (34,1 %) bewertet. Insbesondere die Vorlesungen könnten nach Meinung von 92,7 % der befragten Studierenden auch dauerhaft digital ersetzt werden. Knapp 90 % haben die digitalen Lehrangebote der Klinik mit einer Gesamtnote von 1 oder 2 bewertet.

Diskussion und Zusammenfassung

Im Zuge des digitalen Semesters ließen sich einzelne Lehrformate unterschiedlich gut digitalisieren: Vorlesungen können aus Sicht der Studierenden auch langfristig besonders gut digital abgebildet werden, währenddessen die Digitalisierung des Unterrichts am Krankenbett bisher nicht adäquat möglich ist.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00101-021-01016-4) enthält weitere Abbildungen.

Motion-Tracking Machines and Sensors: Advancing Education Technology

Graduate medical education is predominantly based on a time-based apprenticeship model, with implied acquisition of proficiency after a pre-set amount of clinical exposure. While motion metrics have been used previously to measure skill performance indicators, these assessments have largely been performed on a summative scale to describe the performance of complete tasks or procedures. By segmenting performances of interest and assessing the essential elements individually, a more comprehensive understanding of the aspects in need of improvement for a learner can be obtained. The purpose of this review is to discuss technologies applicable to motion tracking, their benefits and limitations, approaches to data processing, and potential applications based on recent improvements in this technology. Objective analysis of motion metrics may improve educational standards of learning and efficiency by both standardizing the feedback process for trainees and reducing the volume of instructors required to facilitate practice sessions. With rigorous validation and standardization, motion metric assessment may also prove useful to demonstrate competency in technical procedures as part of a comprehensive certification process.