Current opinion in anaesthesiology
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Changing attitudes toward global health are affecting medical education programs at all levels in the USA and abroad. This review describes some of these changes, and how these affect the educational aspects of US global health programs and anesthesia training in developing countries. ⋯ The past 5 years have brought a new global focus on workforce development and education in anesthesia. Programs need to be supported by all stakeholders and monitored for safety, quality and outcomes.
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Curr Opin Anaesthesiol · Dec 2013
ReviewBeyond crisis resource management: new frontiers in human factors training for acute care medicine.
Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare. ⋯ The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.
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Curr Opin Anaesthesiol · Dec 2013
ReviewSimulation and psychology: creating, recognizing and using learning opportunities.
Psychology is relevant for improving the use of simulation in anesthesiology, as it allows us to describe, explain and optimize the interactions of learners and instructors as well as the design of simulation scenarios and debriefings. Much psychological expertise is not used for simulation in healthcare. This article aims to help bridging the gap between professions. ⋯ See the Video Supplementary Digital Content 1 (http://links.lww.com/COAN/A26).
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Advances in surgery and anesthesia have allowed for more surgeries to be done on an outpatient basis. A recent important advance entails availability of suitable recovery criteria to capitalize on the benefits of regional anesthesia for ambulatory surgery. With ever-escalating healthcare costs and expectations for faster recovery, anesthesiologists are now challenged to design anesthesia plans focused on Phase I postanesthesia care unit bypass and early facility discharge. Satisfying the recently published WAKE Score criteria upon operating room exit is associated with hospital cost reductions. This review highlights regional anesthesia techniques with focus on outpatient orthopedics. We also discuss 'multimodalities' addressing postoperative nausea and vomiting prophylaxis, perioperative analgesia (including perineural analgesia), and sedation-hypnosis, which are all central to timely recovery using now-available suitable recovery criteria. ⋯ Routine regional anesthesia use, multimodal postoperative nausea and vomiting prophylaxis, multimodal sedation-hypnosis, and multimodal analgesia, along with avoiding volatile agents and short-duration opioids, can lead to both routine Phase 1 postanesthesia care unit bypass and expedited same-day discharge, when using suitable recovery criteria.