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Abstract Deadline

September 30, 2011

Registration Deadline

October 14, 2011

89 Chestnut Residence & Conference Centre.

www.anesthesia.utoronto.ca/events/facdev11.htm

Faculty Development Day 2011 • 1

Faculty Development Day 2011 Department of Anesthesia Friday, November 11, 2011 University of Toronto 89 Chestnut Residence & Conference Centre

07:00 Breakfast, Registration

Location: Foyer, Colony Grand Ballroom, 2nd

Floor, 89 Chestnut Residence & Conference Centre

07:45 Welcome Message Location: Colony Grand Ballroom, 2

nd Floor

Dr. Martin van der Vyver, Chair, Faculty Development Day 2011 Dr. Brian Kavanagh, Chair, Department of Anesthesia Dr. Bob Howard, President and CEO of St. Michaels Hospital

08:05 Keynote Speaker Location: Colony Grand Ballroom, 2

nd Floor

Dr. Peter Minich,(The Center for Clinical Leadership) "Physical Leadership"

08:35 Discussion

09:00 Parallel Group Sessions #1

1A Interprofessional Education Workshop Leader: Saroo Sharma; Simon Kitto and Patricia Houston

Location: St Patrick North Suite, 3rd

Floor

1B Undergraduate Anesthesia Education Workshop Leader: Lisa Bahrey; Anita Sarmah and Isabella Devito

Location: Lombard Room , 2nd

Floor

1C Feedback Workshop Leaders: Debbie Kwan and Raed Hawa

Location: St Patrick Suite South, 3rd

Floor

1D Changes in RC CE Framework and Mainport Workshop Leaders: Susan Schneeweiss

Location: St Lawrence Suite, 3rd

Floor

1E Anesthesia in the 21st Century: Getting the most out of your iPad/iPhone

Workshop Leaders: Deven Chandra and Nick Lo

Location: St David Suite, 2nd

Floor

1F Use of audience response systems to improve learning Panel participants: Martin van der Vyver

Location: St. Lawrence Suite, 3rd

Floor

10:30 – 11:00 Break and Poster Viewing Sessions Location: Colony Grand Ballroom, 2

nd Floor

1 Development of a competency based curriculum for regional anesthesia elective residents Dr. Imad Awad, Sunnybrook Health Sciences Centre

2 Podcast Educational Needs Assessment Survey of Canadian Anaesthesia Residents

Dr. Derek Rosen, Fellow -UHN-Toronto General Hospital

3 TGH Cardiac Anesthesiology Fellows Manual

Dr. Annette Vegas, UHN-Toronto General Hospital


4 The Development and Integration of a Longitudinal Airway Curriculum in the Anesthesia Residency Program

Dr. Eric You Ten, Mount Sinai Hospital

5 Creating and measuring change in ICU consent process: CHELO (Checklist to meet ethical & legal obligations

Dr. Andrew Cooper,

6 Scarcity – The Context of Rationing in an Ontario Intensive Care Unit: A Qualitative Case Study

Dr. Andrew Cooper

7 Learning Curves for Qualitative Ultrasound Assessment of Gastric Content

Dr. Javier Cubillos, Fellow - Mount Sinai Hospital

8 Virtual Interactive Cases for simulating preoperative assessment

Dr. Scott Beattie, UHN-Toronto General Hospital

9 Developing a pediatric pain management handbook at a tertiary children’s hospital

Dr. Naser Basem, The Hospital for Sick Children

10 A novel integrated pediatric pain curriculum.

Dr. Naser Basem, The Hospital for Sick Children

11 A novel tool for a needs assessment for enhancing pediatric anesthesia knowledge, skills and patient management

competency in a middle east setting. Dr. Naser Basem, The Hospital for Sick Children

12 Becoming an educator in simulation – current status and future directions

Dr. Elaine Ng, The Hospital for Sick Children

13 Changing Behaviour through Peer Assessment

Dr. Matt Kurrek, Scarborough Hospital

14 Open Medicine for Improved Medical Education and Healthcare Delivery

Warren Luksun, Resident –University of Toronto

15 Open POCUS: an Open Access Inter-departmental Educational Initiative at University of Toronto

Warren Luksun, Resident –University of Toronto

11:00 - 12:30 Parallel Group Sessions # 2 2A Interprofessional Education

Workshop Leader: Saroo Sharma; Simon Kitto and Patricia Houston

Location: St Patrick North Suite, 3rd

Floor

2B Undergraduate Anesthesia Education Workshop Leader: Lisa Bahrey; Anita Sarmah and Isabella Devito

Location: Lombard Room , 2nd

Floor

2C Feedback Workshop Leaders: Debbie Kwan and Raed Hawa

Location: St Patrick Suite South, 3rd

Floor

2D Changes in RC CE Framework and Mainport Workshop Leaders: Susan Schneeweiss

Location: St Lawrence Suite, 3rd

Floor

2E Anesthesia in the 21st Century: Getting the most out of your iPad/iPhone

Workshop Leaders: Deven Chandra and Nick Lo

Location: St Davids Suite, 2nd

Floor

2F Use of audience response systems to improve learning Panel participants: Martin van der Vyver

Location: St. Lawrence Suite, 3rd

Floor


12:30 - 13:30 Oral Presentations Moderator: Dr. Sheila Riazi and Dr. Clyde Matava

Location: Colony Grand Ballroom, 2nd

Floor

1 Department of Anesthesia‘s CME website: What is it and how can module authors use it for academic promotion? Dr. Sharon Davies, Mount Sinai Hospital

2 In situ simulation sessions in the operating room: an unexpected opportunity to identify system errors

Dr. Elaine Ng, The Hospital for Sick Children

3 Optimizing Podcast technology as an innovative E-learning tool in medical education - the role of mental practice and

modeling Fahad Alam

4 The use of an interactive 3D anatomic model to improve initial performance in ultrasound scanning of the spine Dr. Ahtsham Niazi, UHN-Toronto Western Hospital

5 The effect of mental practice on crisis resource management: A simulation study

Dr. Megan Hayter, St. Michaels Hospital

Closing remarks: Dr. Martin van der Vyver, Chair, Faculty Development Day 2011

13:30 - 14:00 Lunch

Location: Colony Grand Ballroom, 2nd

Floor

14.00 - 14.30 Awards Presentations Faculty Development Day 2011: Best Oral Presentation Award Faculty Development Day 2011: Best Poster Presentation Award UT Departmental Teaching Awards:

The Dr. John Desmond Award (for excellence in undergraduate teaching) The Dr. Gerald Edelist Award (for excellence in postgraduate teaching) The David Fear Award (for excellence in continuing medical education and professional development The Interprofessional Teaching Award (for outstanding teaching both within, and outside, the anesthesia community)

14:30 Adjournment

―This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada and the Canadian Anesthesiologists‘ Society.‖


Guest Speaker Dr. Peter J. Minich

“Physical Leadership”

Peter Minich graduated from Queen‘s University with a medical degree in 1987. He then went on to complete his surgical training, graduating from the urology program at the

University of Toronto in 1992. In the first decade of his career he directed 2 transplant programs in Chicago and Nashville. In addition to specializing in transplantation, his urologic focus included prostate cancer and sexual dysfunction. During this period he certified in both laparoscopic and robotic surgery. His experience both in Canada and the United States in which he saw how system failure was compromising patient outcome pushed him to study the problem. He completed his PhD, awarded with distinction, in organizational leadership at Vanderbilt University in 1999. His research was focused on modeling physician leaders. Furthering his interest in psychology, he was invited to participate and teach in the first Master‘s program in positive psychology at the University of Pennsylvania in 2006. During this period he studied the effects of thought and emotion on behavior. This research furthered his expertise in both the psychology of leadership and the interplay between mental wellness and disease- an area of critical importance in his clinical practice. Minich‘s career has been strongly influenced by his desire to create environments in which patients achieve the best possible outcomes. He has twice been awarded the Royal College Fellowship in medical Education and has co-authored a book with Terrence Deal, Sick Patients Sicker System. In 2008, in addition to clinical responsibilities, he served as Expert Advisor, Leadership and Medicine, with the Canadian Medical Association. He continues to practice surgery in Toronto. He is on faculty at Cleveland Clinic, and is Chief of Urology at Cleveland Clinic Canada


POSTERS

Poster 1: Development of a competency based curriculum for regional anesthesia elective residents

Dr. Imad Awad Sunnybrook Health Sciences Centre Rationale: Elective residents at the University of Toronto Anesthesia Residency Program spend 30 days in a dedicated regional anesthesia block room at the Holland Orthopedic and Arthritic Center. The teaching method at this center is mainly via apprenticeship approach: trainees learn the principles of regional anesthesia (ultrasound and nerve stimulation techniques) by observing a skilled mentor and then replicating his or her skills. A more structured, competency based model of teaching is needed in accordance with the current guidelines published by ASRA and ESRA1,2. This approach will enhance and consolidate the resident theoretical knowledge and practical hands on skills of regional anesthesia. Goals and Objectives of the curriculum: • To standardize educational content and educational input by educators. • To develop a bench model training module to enhance the skills of ultrasound imaging before applying it at

the bedside. Educational Strategies and Implementation: 1. Set up Educational targets:

Using the Delphi method, the regional anesthesia faculty members at the Holland Orthopedic and Arthritic Center agreed on a set of educational targets for the regional elective rotation after 3 rounds of feedback.

2. Assign educators to a given educational target: Two-three faculty members were assigned to each core competency. They prepared the theoretical contents of it to include both theoretical and practical material. Evaluations and Feedback The regional anesthesia resident curriculum will be evaluated at the end of each rotation (monthly) and adjustment will be made accordingly. Both the educator and the trainee will perform the evaluation of the curriculum. References: 1. Sites BD. Reg Anesth Pain Med 2010;35(2 Suppl):S74-80 2. Smith HM. Reg Anesth Pain Med 2009;34:88-94. .


Poster 2: Podcast Educational Needs Assessment Survey of Canadian Anaesthesia Residents

Dr. Derek Rosen Fellow - UHN-Toronto General Hospital

Purpose:

Audiovisual podcast use is increasing in medical education. A major limitation of maintaining high user rates

in podcasting is the development of high quality content that matches the needs of the targeted user-group.

We conducted a survey to determine the perceived podcast content needs of Anesthesia residents across

Canada.

Methods:

Local ethics board approval was obtained. An electronic survey was emailed to all Anesthesia residents

(years 1-5) across Canada via their program directors. It was divided into 4 sections:

Current use of medical podcasts, Preferred content (subdivided into basic sciences, procedural, clinical and

professional topics), Preferred format and Demographics. Descriptive statistics were used to analyze

results.

Results:

There were 659 Anesthesia residents across Canada in 2010-11 training year.

10/16 universities responded, representing 443 residents.

Of 162 respondents, 60% have used medical podcasts.

Podcasts were most commonly used for routine study.

Pharmacology/physiology‘ topics were the most requested basic science content, ‗regional anesthesia‘ and

‗advanced airway techniques‘ were the most requested procedural podcasts, ‗challenging clinical cases‘ for

clinical content podcasts, and ‗crisis management and anesthesia‘ the most requested content for

professional topics. 73% respondents were ‗very likely‘ to access podcasts of practice oral exams. Pre/post

podcast multiple choice questions were perceived as the best method to facilitate knowledge retention.

Conclusion

Our initial results show high podcast awareness amongst respondents with consistent perceived needs in

core basic science topics and some variation in the other content groups.

Interest in the oral exam format for podcasts suggests this is an area for development.


Poster 3: TGH Cardiac Anesthesiology Fellows Manual

Dr. Annette Vegas UHN-Toronto General Hospital Introduction: The TGH Cardiac Anesthesiology Fellows Manual was conceived as a resource for new cardiac anesthesia fellows working in the cardiovascular intensive care unit (CVICU) at the Peter Munk Cardiac Center (PMCC) at Toronto General Hospital (TGH). The trend over recent years is for fewer, but more complex cardiac surgery patients. This has offered new challenges in the perioperative management of these patients. This manual presents the progressive changes in our practice, particularly in CVICU. It updates and emphasizes with the use of tables and diagrams important information about perioperative practices that have been implemented over recent years. Methods: The editors, Dr Jason Toppin and Dr Annette Vegas, have created the 7th edition of the manual consisting of 385 pages in full color. This project benefitted from the expertise of 34 multi-disciplinary contributors who shared their knowledge and experience in many clinical settings. The final product is a portable manual detailing the practice of perioperative cardiac anesthesia at TGH. The material is presented in 3 sections: 1) Cardiac Anesthesia, 2) Cardiac Surgical Procedures and 3) Cardiovascular Intensive Care Unit. Results: Although the manual is intended to be a guide to the specific cardiac anesthesia practices and postoperative care at TGH, it has been in great demand from institutions who are interested in our practices and standards of care. It is of practical use to all medical professionals. Previous editions have been distributed around the world by the international Fellows who have trained here.


Poster 4: The Development and Integration of a Longitudinal Airway Curriculum in the Anesthesia Residency Program

Dr. Eric You-Ten Mount Sinai

RATIONALE Studies showed poor management of unanticipated difficult airways by anesthesia residents contributed to significant adverse patient outcomes. Currently, an airway management education module is lacking in the Anesthesia Residency(PGY1-5) Program at the University of Toronto. OBJECTIVES Assemble an inter- / intra-disciplinary team to develop a comprehensive syllabus with the following goals: (i) Meeting the objectives of the FRCPC Airway Evaluation and Management (ii) Providing multi-teaching modalities: didactic lectures, technical airway skills, airway crisis management skills; (iii) The use of multi-model modalities: mannequins, virtual fibreoptic bronchoscopy, pig trachea, human cadavers, high fidelity patient-simulator. METHODOLOGY Design: A longitudinal airway course from PGY1-PGY5 consisting of didactic lectures, practical airway skills and simulated airway crisis. • PGY1 Level: Comprehensive Introductory Airway Seminars that focus on the objectives of the FRCPC

Airway Evaluation and Management • PGY2 – 3 Levels: Achieving clinical competencies of a limited number of rescue techniques of

unanticipated difficult airway using evidence based from the guidelines of the Difficult Airway Society meetings. Rescue airway skills will be practiced electively on patients in the operating room. Competency will be recorded on an online resident logbook and staff evaluation form.

• PGY3-4 Levels: Airway Crisis Simulation Seminars will focus on case-based discussion and crisis resource management skills.

• PGY5 Level: Airway Crisis Simulation Seminar and a review of surgical airway techniques. EVALUATION Survey questionnaires Online evaluation Evaluating Crisis Resource Management Skills with ANTS POTENTIAL BENEFITS To maintain competent airway technical skills and crisis resource management skills that will improve patient safety and outcome.


Poster 5: CREATING AND MEASURING CHANGE IN ICU CONSENT PROCESS: CHELO (CHECKLIST TO MEET ETHICAL & LEGAL OBLIGATIONS)

Dr. Andrew B Cooper Sunnybrook Health Sciences Centre

BACKGROUND:Simple checklists and bundled quality improvements have been shown to improve safety and reduce complications in diverse surgical and critical care settings. We developed a simple checklist and an information bundle to reduce error in the consent process for critically ill patients. Our change strategy is grounded on positive deviance and follows the framework given in Heath and Heath (2010). METHODS: Through a consensus process 4 experts developed CHELO based on the Health Care Consent Act and our own prior research. Our intervention consisted of the CHELO bundle (consent checklist , substitute decision maker pamphlet , Azoulay family information leaflet,RWJ values information sheet) and an associated change strategy. 72 h post admission to ICU the bundle was given to the patient's nurse. In 30 minute training sessions for physicians and nurses we recruited participants' affective connection to the consent process. We also explained how to deliver the bundle to the family and how to conduct interdisciplinary data collection. Measurement of effectiveness is presented as CHELO-U (per patient analysis; percentage normalized completion rate MNCR- 8 checklist items) , CHELO-B ( MNCR- 3 bundle items). RESULTS CONCLUSIONS: CHELO U score increased from baseline during the intervention period, and change was sustained two weeks post intervention. CHELO B increased at all points after baseline assessment indicating increased bundle distribution to families. Our change strategy may be effective in creating conditions for a cultural shift in our intensive care unit.


Poster 6: Scarcity – The Context of Rationing in an Ontario Intensive Care Unit: A Qualitative Case Study

Dr. Andrew Cooper Sunnybrook Health Science Centre

Background: Rationing critical care beds may lead to serious adverse outcomes for patients denied access. However, a decision to ration at the bedside depends on the clinician‘s perception of scarcity. The phenomenon of scarcity has not been explored thoroughly in this setting. Methods: Qualitative case study in the Critical Care Unit (CrCU) at Sunnybrook Health Sciences Centre, a large urban university-affiliated hospital in Toronto, Ontario, Canada. Theoretical sampling was used to recruit ICU attending physicians , critical care subspecialty fellows involved in the care of mechanically ventilated patients in the CrCU, intensive care unit (ICU) resource nurses holding these positions for at least 2 years, and patient-flow administrators holding these positions for at least 2 years. Modified thematic analysis was performed independently in duplicate, which involved reading all the data, developing a coding scheme, coding the data, and identifying concepts that related to specific aspects of the phenomenon of scarcity. Results: Interviewed were 12 attending physicians, 4 critical care fellows, 2 nurse managers and 4 nursing team leaders. Scarcity was perceived as an obligation to prioritize Trauma patients over others for admission. Reasons for the perception of scarcity were 1) practises of non ICU physicians such as medical oncologists ( failure to specify treatment plans) or surgeons ( initiating elective high risk surgery), 2) family demands for life support, 3) clinicians‘ perception of a lack of legal support if they opposed these , and 4) inability to transfer patients to non ICU care settings. Implications of scarcity included 1) early, possibly unsafe patient transfers, 2) temporizing critical care in unsafe locations and 3) inter professional conflicts. Conclusions: Rationing at the bedside in the ICU can occur when patients are de-prioritized for care in a context of scarcity which may be only temporary. We found a strong influence of non medical factors on prioritization activity, both for admission and discharge.


Poster 7: Learning Curves for Qualitative Ultrasound Assessment of Gastric Content

Dr. Javier Cubillos Fellow – Mount Sinai Hospital

In patients going under sedation/general anesthesia, stomach food residue is considered a major risk factor for pulmonary aspiration of gastric contents. The resulting compromise after aspiration is associated with significant morbidity and mortality. Recent clinical studies have demonstrated that ultrasonographic focused assessment of the gastric antrum is a feasible imaging tool to qualitatively evaluate the stomach content. However, an expert sonographer has performed the assessments in these previous studies. Anesthesiologist interest in this specific ultrasound application is growing, so it is important to determine the training needed to accomplish competence while constructing learning curves through Cumulative Sum Method Graphs In this prospective observational blinded study, we aim to determine how much training is needed for an anesthesiologist to achieve competence in bedside ultrasound technique for qualitative assessment of gastric content in non-pregnant patients. Anesthesiologist will go through a systematic training, followed by evaluation stage. This learning process will have: - Teaching: reading material and video/picture library to review. Hands-on workshop performed by expert ultrasonographer with a systematic approach and demonstration on gastric ultrasound assessment on volunteers randomized to empty, fluid or solid stomach content. Individual training and feedback on different gastric content groups will be given after each series of scannings. - Evaluation: Series of scannings performed by each anesthesiologist followed by confirmation and feedback from expert ultrasonographer We expect that reliable information obtained from gastric ultrasounds in hands of proper trained anaesthesiologist may help clinicians in the future to better assess aspiration risk and guide anesthetic and airway management.


Poster 8: Virtual Interactive Cases for simulating preoperative assessment

Dr. Scott Beattie UHN – Toronto General Hospital

Training anesthesiologists and nurses in preoperative assessment is an ongoing activity in the Department of Anesthesia. We have developed Virtual Interactive Case (VIC) software for creating simulations of patient encounters in the preoperative clinics. VIC will facilitate this training by creating examples of surgical patients with risks to anesthesia that must be determined by conducting a virtual preoperative assessment. These cases allow the user to take the patients history, conduct a functional assessment and physical exam, and order appropriate laboratory tests, to determine potential threats to the induction and maintenance of anesthesia. At the end of their assessment, the user must select the risks presented by the patient, and the appropriate interventions and modifications of the anesthetic procedure in response to these risks. After selecting the risks and interventions, the program provides a debriefing, listing the actions they took in conducting the assessment that were essential, the actions that were missed and the actions that were inappropriate. A score reflecting their performance, and the time and cost incurred are compared to that of an experienced clinician. The software consists of a VIC Player and a VIC Editor for creating the cases. VIC cases can be played on the users‘ computer or placed on a Web server. The VIC Editor allows rapid creation of cases by modifying a template case, and by dragging and dropping actions from other cases. VIC cases can also be used for student evaluation by activating a log tracking the users actions and their debriefing and score.


Poster 9: Developing a pediatric pain management handbook at a tertiary children’s hospital

Dr. Naser Basem The Hospital for Sick Children

Objective Pediatric pain remains largely under treated in many institutions in spite of the relative ease of managing it. Inadequate acute pain management in children has been attributed largely to the lack of knowledge of appropriate pharmacological and non-pharmacological regimens of physicians or nurses. To meet this need, we developed a pain management handbook for children at a tertiary institution. Methods Through interactive sessions with acute and chronic pain management physicians and nurses, a pain management handbook was designed. Content was informed from topics covered in regular training sessions, clinical rounds and clinical protocols. Feedback and comments informing and guiding the development of the booklet were sought from peer anesthesiologists. Outcome A 235 pain management handbook was developed. The handbook is divided into two sections. The first section outlines best practice guidelines in acute pain management and the second is educational. The handbook outlines referral criteria to an APS service, diagrams of relevant neural anatomy, ultrasound pictures of nerve blocks, modified summary of the ASRA recommendations, examples of post-operative pain management techniques and some common pain conditions encountered onwards. The handbook has been distributed to the APS since 2009 with requests from many other hospitals. Recommendations Acute pain is almost completely manageable using the techniques outlined in this handbook. Anecdotal evidence already suggests this handbook has been well received by and is a helpful tool towards achieving good pain management in children. Further studies on assessing the impact of this handbook on attitudes and knowledge of all healthcare workers on pain management in children are indicated.


Poster 10: A novel integrated pediatric pain curriculum


Objective. Designing a new pediatric pain fellowship curriculum is a challenging task given the lack of a formalized national frame-work. The most meaningful method of knowledge acquisition and retention for adult learners is experiential learning through real life situations. We present a novel pediatric pain fellowship curriculum combining didactic teaching, workshops with clinical rotations providing experiential learning in various specialties providing experiential learning on the management of pain in children. Methods In 2010 a working group of pediatric pain specialists from the acute pain, chronic pain, and procedural pain and sedation services was assembled at the Hospital of Sick Children to develop a list of objectives and topics for a pediatric pain curriculum. An iterative process finalized the content and built support for the final curriculum based on the CANMEDS roles. Outcomes. The curriculum lasts 12 months and covers objectives and competencies in four areas: clinical, research, education/teaching and administration. A total of 26 topics, delivered in modules, were developed covering various pediatric pain knowledge areas. Instructional formats will follow an integrated format including interactive lectures, workshops, clinical case management from multiple disciplines (Figure 1). Educational outcomes will be assessed using written examinations, peer review, self-evaluations and a research project. Discussion. The development of the pain fellowship curriculum has met our institution‘s goal to develop novel programs to enhance pain management in children. This is a novel curriculum in Canada which will allow fellows to acquire a clear and concise understanding of the important aspects of pediatric pain management, improvement methods and competencies needed to improve patient care. The curriculum will be outlined on the poster.


Poster 11: A novel tool for a needs assessment for enhancing pediatric anesthesia knowledge, skills and patient management competency in a middle east setting.


Introduction. An institution-specific needs assessment is an important part of the successful development and implementation process of an effective curriculum. is important in the development of a pediatric anesthesia skills enhancement program for anesthesia specialists (fellows) in a middle east country. A needs assessment gathers information on about the educational needs of learners, available resources, motivation to learn and potential obstacles. These inform the curriculum development and assist with its implementation. We describe a needs assessment process we used in the development of a pediatric anesthesia skills enhancement program for anesthesia specialists (fellows) in a middle east country. This paper outlines a systematic methodology of needs assessment for pediatric anesthesia specialists. Methods. Institutional approval was obtained. Content areas covering knowledge, skills and patient management were developed based on a systematic literature review, an anonymous survey with topic rankings and informal interviews. Questionnaires listing the content areas were sent to anesthesia specialists. The respondents were asked to indicate on a scale of 1-10, their current level of expertise, ideal level of expertise against each content area. A need score for each content area was from the difference between ideal and current level of expertise with a maximum need score of 9. Results A total of 25/25 (100%) anesthesia specialists completed the survey. Eleven (47%) of respondents have been in anesthesia for 11-20 years. Survey responses show that technical skills such as ultrasound guided regional, single lung ventilation received high rankings (figure 1). Lectures without questions and answers, online podcasts and journal club were rated as ‗ineffective‘ in improving knowledge and skills in pediatric anesthesia (table 1). Conclusions The learning needs of pediatric anesthesia specialists have been identified and are being used to develop a curriculum aimed at enhancing their current knowledge, skills and patient management competencies. Furthermore, information on perceived ‗effectiveness‘ of various teaching formats will be useful in implementation of this program.


Poster 12: Becoming an educator in simulation – current status and future directions

Dr. Elaine Ng The Hospital for Sick Children Introduction The Debriefing Workshop (DW) was developed in 2010 as a one-day, small group, inter-professional workshop to teach debriefing for simulation education. Objectives To determine impact of the DW, benchmark current status and explore future directions for educational interventions. Methods A web-based 20 question survey was sent by email to all DW participants to generate qualitative and quantitative data using a 5-point Likert scale and open ended questions. Results Response rate was 22/26 (84.6%; 9 nurses, 7 respiratory technologists, 5 physicians, 1 simulation coordinator). Simulation was used for teaching by 86% of participants. >90% reported the DW had high to very high impact on their knowledge of high fidelity simulation and debriefing, and they learned varied perspectives from the other inter-professional participants. >65% stated it improved the way they communicated and introduced them to new colleagues. As a result of the DW, 50% of participants had successfully implemented a teaching session using simulation. 77% indicated use of the knowledge and skills learnt in debriefing in real life events. 71% identified time as the main barrier to utilize simulation in education. Themes that emerged from the open ended questions revealed need for advanced and refresher courses and practice opportunities on debriefing. Conclusions The one-day DW enabled educators to utilize simulation as a teaching tool and these debriefing skills have been translated to daily practice. It also led to development of new courses and collaboration which fostered inter-professional education and networking. Need for further support and continuing education in debriefing was identified.


Poster 13: Changing Behaviour through Peer Assessment

Dr. Matt Kurrek Scarborough Hospital Introduction: The profession has a duty to serve and protect the public interest in accordance with the Regulated Health Professions Act. Physicians recognize their responsibility and have developed professional competencies through the CPSO‘s Quality Assurance (QA) Program. We intended to evaluate outcomes of anesthesiologists‘ peer assessments and as see if changes were implemented if deficiencies had been identified. Methods: The CPSO provided aggregate, anonymous data for random and age-related peer assessments from 2006-2010. Physicians‘ abilities to take histories, conduct examinations, order diagnostic tests and to identify the appropriate course of action were assessed through formal review of the medical records followed by an interview. Each report was reviewed and the Quality Assurance Committee recommended a re-assessment or interview (to determine the need for re-assessment or a more in-depth assessment) if concerns were identified. Results: During 2006 until 2010 a total of 5,550 physicians (218 anesthesiologists) were assessed and no concerns were identified for 4698 of these physicians (159 anesthesiologists). A total of 576 physicians (32 anesthesiologists) underwent a repeat assessment and 393 of the physicians and 23 of the anesthesiologists were found to have addressed the concerns identified during the original assessment. The average cost for a peer assessment in 2010 was $1,700. Discussion: Approximately 84% of physicians (74% of anesthesiologists) were found to have satisfactory records and level of care. About 68% of physicians (72% of anesthesiologists) who required a re-assessment made changes that addressed the concerns. It may be cost-effective to try to identify physicians

(anesthesiologists) ‗at-risk‘.


Poster 14: Open Medicine for Improved Medical Education and Healthcare Delivery

Warren Luksun Resident – University of Toronto Authors: Author: Azad Mashari and Warren Luksun, University of Toronto, Department of Anesthesia. Keywords: Open Access, open medicine, medical education, healthcare delivery The ability to access, study, and build upon previous work is at the core of innovation. Medical research and education are no exception. Currently, most refined medical knowledge is only available via pay-for-access journals and collections that hinder collaboration and dissemination of knowledge: providers in poorer areas who cannot afford to pay, providers in richer ones who choose not to, and patients who are deprived of the benefits[1]. Inspired by public knowledge projects such as Wikipedia and MIT's OpenCourseWare program[2], many educators and researchers are increasingly releasing their work under open access licenses. This paradigm of high quality, independent, peer reviewed, and widely available knowledge can improve medical innovation, education and care on a global scale. As suggested in the BMJ, ―An expert (that is, doctor) moderated repository of the knowledge base, in the form of a medical wiki, may be the answer to the world's inequities of information access in medicine if we have the will to create one.‖[3] With licenses such as those of Creative Commons[4], authors can facilitate dissemination and collaboration while increasing academic citations and credit. Most studies to date show consistent increases in usage and citations[5][6]. Moreover, open contributions are protected by the same robust laws afforded to close/restricted works. [7] Bringing the power of open access to collaborative development of educational tools promises to enhance innovation while reducing redundancy and improving the quality of both education and care. Keywords and Text: 243 Words. 1. Maskalyk, J. 'Why Open Medicine.' Open Medicine. http://www.openmedicine.ca/article/view/74/3 2. http://ocw.mit.edu 3. Giustini, D. 'How Web 2.0 is Changing Medicine.' BMJ. http://www.bmj.com/content/333/7582/1283.long 4. http://creativecommons.org 5. Eysenbach G. Citation Advantage of Open Access Articles. PLoS Biol 2006 May;4(5):e157. 6. Castillo M. Citations and Open Access: Questionable Benefits. American Journal of Neuroradiology 2009 Feb;30(2):215 -216. 7. Stallman R. Misinterpreting Copyright—A Series of Errors. 2010; Available from: http://www.gnu.org/philosophy/misinterpreting-copyright.html


Warren Luksun Resident – University of Toronto Authors: Azad Mashari and Warren Luksun, Department of Anesthesia, University of Toronto. Point of Care Ultrasound (POCUS) is bringing about substantial changes in medical practice. POCUS has demonstrated considerable value in multiple applications such as vascular access, regional anesthesia, trauma assessment, and hemodynamic evaluation. Emerging applications include focused trans-thoracic echocardiography, focused lung ultrasound, spinal ultrasound as well use of POCUS images for education and patient communication . At the University of Toronto, research and clinical applications of POCUS are fractionated across multiple departments. Anesthesia, Critical Care, Internal Medicine, Emergency Medicine, Pediatrics, and Radiology are all engaged in independent research, education, and delivery of care with notable redundancy. Collaboration and knowledge translation has also been limited by proprietary courseware. With the support of the Department of Anesthesia and the Vice Dean of PGME, a POCUS working group was formed earlier this year and currently consists of faculty and residents from Anesthesia, Internal Medicine, Emergency Medicine, Pediatrics, Critical Care, and Radiology. Using an open access model similar to that used by medical journals such as Open Medicine, the group aims to bring together experts from diverse fields to assemble a dynamic collection of POCUS educational resources with copyright licenses that maximize resource-sharing and collaboration while maintaining academic credit. Development plans include materials that can be used for independent learning and creation of custom-tailored curricula. Removing barriers to collaborative development will enhance innovation, training, and patient care

Poster 15: Open POCUS: an Open Access Inter-departmental Educational Initiative at University of Toronto


ORAL PRESENTATIONS

Oral Presentation 1: Department of Anesthesia's CME Web Site: What is it and how can module authors use it for academic promotion

Dr. Sharon Davies Mount Sinai Hospital

Following the establishment of the RCPSC MainCert program, there was a need for accredited online continuing education for practicing anesthesiologists, particularly community physicians and long distance learners with limited access to educational events. In addition, this year the RCPSC revised the framework of the credit system, limiting the credits for conferences and teaching rounds while increasing the emphasis on self-directed learning (Section 3). These activities will now receive 3 credit hours/hour of participation and consequently one can anticipate an increase in the demand for accredited online programs. I have previously designed and developed a continuing education online program that is now accredited under Section 3. Presently, the site contains 15 educational modules which can be viewed on the Department of Anesthesia‘s web site. Last year participation climbed to an all-time high with 688 modules completed. The typical module format includes clinical cases, interactive discussions, and a ―lecture‖ on the topic. Any questions from participants and the author‘s answers are posted on a discussion board. In addition, participants are able to evaluate their learning through an online examination. Feedback regarding the module‘s design and effectiveness is encouraged through a short evaluation survey and has been excellent. Requests for more modules are frequent and my hope is to encourage more faculty to produce additional modules. Data is maintained regarding the number of anesthesiologists completing each module, their grades on the examination and their evaluation of the module. This information can be provided to the authors and added to their educational CV.


Oral Presentation 2: In situ simulation sessions in the operating room: an unexpected opportunity to identify system errors

Dr. Elaine Ng The Hospital for Sick Children

Introduction In situ simulation allows for practice of crisis resource management in the actual workplace. Six simulation sessions were conducted in the OR for nurses and anesthesiologists. The computerized mannequin (Simbaby®, by Laerdal) was set up in an OR. Two clinical scenarios of similar complexity were conducted with debriefing after each case. Participants completed a multiple choice evaluation of the session and documented their reflections in a ―one minute paper‖. The objective of the study is to identify themes and perceptions of competence and confidence in team function. Methods Research was approved by local Research Ethics Board to conduct a retrospective qualitative analysis of the evaluations and reflections. Results There were 40 participants (30 nurses, 10 anesthesiologists). The themes indicated the need for clear communication, awareness and self-reflection of medical knowledge and familiarity with equipment, and importance of task designation and role identification. System issues identified that the location of certain resuscitative medications was not obvious. The crash cart designated for use was not configured the same way as other crash carts in the area. Treatment protocols were not immediately available. The telephone at the main OR desk was found to be on voicemail when help was required. Conclusions and discussion In situ simulation allows practice of resuscitation and crisis resource management skills. In addition, system errors and latent safety threats were identified and have since been corrected which may enhance patient safety.


Oral Presentation 3: Optimizing Podcast technology as an innovative E-learning tool in medical education - the role of mental practice and modeling

Fahad Alam Resident – University of Toronto Purpose: The goal of this study, currently in progress, is to identify whether Podcasts are effective for learning complex clinical decision-making. Furthermore, we examined the role of two learning models as basis for podcast-based education: mental practice and modeling. Methods: Thirty medical students participated in this prospective randomized controlled trial. Students were assigned to one of four groups: control (no modeling, no MP), modeling, MP, combined modeling and MP. Students viewed one of four versions of the podcast, according to their randomization group. One week later, students were asked to manage an airway crisis, using mannequin-based simulation. Knowledge was assessed by multiple-choice pre (baseline) and post-intervention (one-week retention) quizzes. Students' performance during simulated airway crisis will be assessed by 2 blinded experts at the end of data collection. Results: Preliminary one-way ANOVA of the pre-intervention quiz scores showed no significant differences between the groups at baseline (p=.645). A mixed ANOVA of time (pre/post-intervention) and group (control, MP, modeling, MP+modeling) revealed an improvement in all groups from pre to post-intervention quizzes (p=.006). The MP and modeling groups showed significantly higher post-intervention scores than the control group (both p<.05) with no difference in comparison to each other. The combined MP+modeling group had significantly higher post-intervention scores than all other groups (all p<0.05). Conclusion: Preliminary results support our hypothesis that the effectiveness of Podcasts for knowledge acquisition can be enhanced with the addition of either mental practice or modeling. The most effective method may involve a combination of both mental practice and modeling.


Oral Presentation 4: The use of an interactive 3D anatomic model to improve initial performance in ultrasound scanning of the spine

Dr. Ahtsham Niazi UHN - Toronto Western Hospital

The use of ultrasound for neuraxial blockade is a new application of technology that is rapidly becoming accepted as a standard of care with research supporting both an improvement in success and a reduction in attempts. This has posed challenges to teaching neuraxial anesthesia as new skills must be learned. We have created a Web site (http://pie.med.utoronto.ca/vspine) with two interactive educational modules to assist with teaching and learning the use of ultrasound in regional anesthesia of the lumbar spine. One module covers spinal anatomy using an interactive 3D model of the spine and the second module covers sonoanatomy showing the cross sections of the 3D spinal model which correspond to the ultrasound recordings. This ultrasound module also provides a simulation of a pre-puncture ―scout‖ scan of the lumbar spine. The educational benefit of the ultrasound module was evaluated by randomly assigning 16 PGY1 anesthesia residents to a control group with password protected access to only the lumbar anatomy module, and a study group with access to both the anatomy and ultrasound modules. The residents had password protected assess toe the modules for two weeks following a workshop covering regional anesthesia of the spine. At the end of the two weeks, their performance was evaluated using a 12 item task-specific checklist while carrying out a scout scan on a live model. The control group scored 5.88 (SD = 3.60) while the study group scored 10.13 (SD = 2.47) with a significant difference of 4.25 between the groups (p < 0.02).


Oral Presentation 5: The effect of mental practice on crisis resource management: A simulation study

Dr. Megan Hayter St. Michael‘s Hospital

Background: Mental practice (MP), defined as the ‗symbolic rehearsal of physical activity in the absence of any gross muscular movements‘ has been used in sport and music to enhance performance. In healthcare, MP has been demonstrated to improve technical skills performance of surgical residents. The effect of MP on non-technical skills (NTS) in high stakes clinical scenarios has yet to be investigated. We aimed to investigate the effect of MP on NTS performance during simulated crisis scenarios. Methods: Following REB approval, forty anesthesia residents were recruited. After an orientation to the simulated environment, all subjects were randomized to either the MP or control groups. The MP group participated in 20 minutes of MP by reviewing a script based on key anesthesia crisis resource management (ACRM) principles. The control group participated in an independant 20 minute session that consisted of an educational task unrelated to ACRM. Immediately following, each subject managed a high-fidelity simulated peri-operative crisis scenario. Using the validated Ottawa Global Rating Scale, two blinded independent raters evaluated the NTS performance of the recorded scenarios. A Mann-Whitney test was used to compare the NTS performance between the two groups. Results: No significant difference was found between groups. Conclusion: Unlike technical skills, NTS do not seem to improve with MP. Our study was powered to detect a large of MP; however, the effect of MP on NTS performance may be small. Therefore future studies investigating the effects of MP on performance may benefit from a larger sample size


Acknowledgements

The University of Toronto, Department of Anesthesia wishes to thank and acknowledge the following sponsors for the generous unrestricted educational grants provided in support of Faculty Development Day 2011:

―This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada and the Canadian Anesthesiologists‘ Society.‖

Faculty Development 2011 Planning Committee

Dr. Martin van der Vyver – Chair, Faculty Development Day Dr. Clyde Matava Dr. Sheila Riazi Dr. Craig Daniels Mr. Gary Cronin Ms. Jennifer Morris

teaching ls assess y s guide 2011 education s residents procedures mentor … · 2013-07-23 ·...

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