Medical specialties have evaluated malpractice claims in residents, but to the best of our knowledge, malpractice claims have not been evaluated in anesthesiology residents.
The Westlaw legal database was queried for all malpractice litigation cases involving anesthesiology residents in the United States from January 1959 through December 2018. The cases were divided into 2 cohorts by year (before and after 1990) to account for the differences in patient safety features and monitoring available in the different time periods.
Ninety cases were included in the analysis. The median (interquartile range) for inflation adjusted payments was $1 140 544 (0 to 4 158 589). There was no association between the year the claim was filled and the payment amount, Spearman rho = -0.17,
= 0.15. In contrast, for claims that occurred in the intraoperative period, there was a moderate negative association between the year of the claim and the inflation adjusted payment, Spearman rho = -0.45,
= 0.003. Payments were greater if the event occurred in the postoperative period, median of $4 250 000 (959 000 to 55 595 000) compared to events that happened in the intraoperative period, median of $1 039 000 (0 to 3 802 000) and preoperative periods, median of $212 000 (0 to $3 982 000),
= 0.02.
The reduction of liability across the years with malpractice claims that resulted from the intraoperative period suggest that the continued patient safety initiatives implemented by anesthesiology specialty has resulted in less liability to trainees and may stimulate future initiatives targeted to the postoperative period.
The reduction of liability across the years with malpractice claims that resulted from the intraoperative period suggest that the continued patient safety initiatives implemented by anesthesiology specialty has resulted in less liability to trainees and may stimulate future initiatives targeted to the postoperative period.
The Accreditation Council for Graduate Medical Education (ACGME) mandates minimum numbers of cases in many specialties, including anesthesiology, but resident scheduling is often done on the basis of time spent on each rotation rather the number of opportunities for specific cases, risking uneven case distribution, particularly for low-volume cases. We used the neuroanesthesia rotation as a model to evaluate a system to more evenly distribute ACGME-mandated cases among residents and assessed the effects on their perceptions of their experience on the rotation.
In November 2018, we instituted a targeted operating room scheduling system at our institution by making specific daily assignment requests for anesthesia residents on the neuroanesthesia rotation. We used Shewhart control charts to analyze the variation in case distribution among all resident rotations (N = 91) from January 2018 to October 2019. We then surveyed residents who had experienced both systems (n = 15) and those who had experienced only the old system (n = 16).
Shewhart p-charts of the proportion of ACGME-mandated cases assigned to each resident showed wide variation under the old scheduling system and a more even distribution under the new system. Residents reported significantly greater perceived fairness of case distribution and balance between their education and service obligations under the new system (response rates 10/16 [62.5%] and 13/15 [86.7%]).
Targeted resident scheduling based on ACGME-mandated case numbers rather than solely time spent on a rotation is feasible and can improve resident perceptions of fairness and balance between education and service, a top priority of the ACGME.
Targeted resident scheduling based on ACGME-mandated case numbers rather than solely time spent on a rotation is feasible and can improve resident perceptions of fairness and balance between education and service, a top priority of the ACGME.
No studies have examined how journal clubs (JCs) are implemented in anesthesiology residency training programs. The goal of the study was to close this gap by (1) examining the format, content, and goals of JCs; (2) identifying features associated with higher resident attendance and JC success; and (3) examining program directors' perspectives on JCs.
A 41-question survey was sent to anesthesiology program directors. Answers were analyzed using multivariable logistic regression, multivariable linear regression, and exploratory factor analysis.
Out of 117 surveys sent across the United States, 80 program directors responded (68.4% response rate). Of the 80 programs, 77 (96.3%) programs have a JC, with 93.2% of them existing for more than 2 years. Most JCs (62.5%) neither formally appraised articles before meetings, nor formally evaluated their JC (59.7%). Faculty alone organized 44.4% and moderated 69.9% of the JCs. The role of residents was primarily limited to presenting selected articles with faculty guidance (83.3%). The average resident attendance was 49.7%. A multivariable linear regression analysis identified mandatory resident attendance, faculty turnout of >5 members, and longer intervals between JC meetings as features associated with higher resident attendance. Only 49.3% of JCs were successful as defined a priori by resident attendance >50% and longevity of ≥2 years. Features associated with JC success based on multivariable logistic regression included mandatory resident attendance and complimentary food.
This largest survey of JCs in anesthesiology found that while JCs are widely established, half of them could be improved.
This largest survey of JCs in anesthesiology found that while JCs are widely established, half of them could be improved.Purpose We describe the creation of computational models of lung pathologies indicative of COVID-19 disease. The models are intended for use in virtual clinical trials (VCT) for task-specific optimization of chest x-ray (CXR) imaging. read more Approach Images of COVID-19 patients confirmed by computed tomography were used to segment areas of increased attenuation in the lungs, all compatible with ground glass opacities and consolidations. Using a modeling methodology, the segmented pathologies were converted to polygonal meshes and adapted to fit the lungs of a previously developed polygonal mesh thorax phantom. The models were then voxelized with a resolution of 0.5 × 0.5 × 0.5 mm 3 and used as input in a simulation framework to generate radiographic images. Primary projections were generated via ray tracing while the Monte Carlo transport code was used for the scattered radiation. Realistic sharpness and noise characteristics were also simulated, followed by clinical image processing. Example images generated at 120 kVp were used for the validation of the models in a reader study.read more
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