Samuel DeMaria

Established models for assessment and maintenance of competency in anesthesiology may not be adequate for anesthesiologists wishing to reenter practice. The authors describe a program developed in their institution incorporating simulator-based education, to help determine competency in licensed and previously licensed anesthesiologists before return to practice. The authors have used simulation for assessment and retraining at their institution since 2002. Physicians evaluated by the authors' center undergo an adaptable 2-day simulation-based assessment conducted by two board-certified anesthesiologists. A minimum of three cases are presented on each day, with specific core competencies assessed, and participants complete a standard Clinical Anesthesia Year 3 level anesthesia knowledge test. Participants are debriefed extensively and retraining regimens are designed, where indicated, consisting of a combination of simulation and operating-room observership. Twenty anesthesiologists were referred to the authors' institution between 2002 and 2012. Fourteen participants (70%) were in active clinical practice 1 yr after participation in the authors' program, five (25%) were in supervised positions, and nine (45%) had resumed independent clinical practice. The reasons of participants not in practice were personal (1 participant) and medico-legal (3 participants); two participants were lost to follow-up. Two of 14 physicians, who were formally assessed in the authors' program, were deemed likely unfit for safe return to practice, irrespective of further training. These physicians were unavailable for contact 1 yr after assessment. Anesthesiologists seeking to return to active clinical status are a heterogeneous group. The simulated environment provides an effective means by which to assess baseline competency and also a way to retrain physicians.

Training in transesophageal echocardiography (TEE) requires a significant commitment of time and resources on behalf of the trainees and the instructors. Training opportunities may be limited in the busy clinical environment. Medical simulation has emerged as a complementary means by which to develop clinical skills. Transesophageal echocardiography simulators have been commercially available for several years, yet their ability to distinguish experts from novices has not been demonstrated. We used a standardized assessment tool to distinguish experts from novices using a commercially available TEE simulator. Anesthesiologists certified in advanced perioperative TEE and anesthesiology resident physicians were recruited into the expert and novice cohorts, respectively. The cohorts were recruited from 2 academic medical centers. The novice cohort received a structured introduction to the basic TEE examination. Both cohorts then proceeded to perform a basic TEE examination involving normal cardiac anatomy, which was evaluated by blinded raters using a standardized assessment tool. The expert cohort consistently demonstrated the ability to obtain standard TEE imaging views in less time and more accurately than the novice cohort during the course of a simulated TEE examination. A simulated transesophageal examination of normal cardiac anatomy in concert with a standardized assessment tool permits ample discrimination between expert and novice echocardiographers as defined for this investigation. Future research will examine in detail the role echocardiography simulators should play during echocardiography training including assessment of training level.

The evolution of simulation from an educational tool to an emerging evaluative tool has been rapid. Physician certification has a long history and serves an important role in assuring that practicing physicians are competent and capable of providing a high level of safe care to patients. Traditional assessment methods have relied mostly on multiple-choice exams or continuing medical education exercises. These methods may not be adequate to assess all competencies necessary for excellence in medical practice. Simulation enables assessment of physician competencies in real time and represents the next step in physician certification in the modern age of healthcare. Mt Sinai J Med 79:140–153, 2012.© 2012 Mount Sinai School of Medicine

The evolution of simulation from an educational tool to an emerging evaluative tool has been rapid. Physician certification has a long history and serves an important role in assuring that practicing physicians are competent and capable of providing a high level of safe care to patients. Traditional assessment methods have relied mostly on multiple-choice exams or continuing medical education exercises. These methods may not be adequate to assess all competencies necessary for excellence in medical practice. Simulation enables assessment of physician competencies in real time and represents the next step in physician certification in the modern age of healthcare. Mt Sinai J Med 79:140–153, 2012.© 2012 Mount Sinai School of Medicine

Background-Key preparation steps are required prior to induction of anesthesia in order to ensure patient safety. Due to time pressure, items may be overlooked or possibly intentionally skipped to save time. Failure to do a proper anesthesia checkout can lead to ...

The preoperative evaluation has a critical role in the perioperative care of day admission surgery (DAS) patients for cardiac and major vascular operations (CVO). Due to increased volume of patients, who are older, need reoperations, and have multiple comorbidities, we opened ...

Cleveland Clinic Journal of Medicine Vol 77 • E-Suppl 1 March 2010 eS25 ... Abstract 14 Use of the BATHE Method to Increase Satisfaction Amongst Patients Undergoing Cardiac and Major Vascular Operations Samuel DeMaria, MD1; Anthony P. DeMaria, MA2; Menachem ...

The use of cocaine and other illicit “club drugs” has become increasingly prevalent, especially amongst teenagers and young adults. Anesthesiologists must deliver safe anesthetic care for surgery no matter the status of the patient. Accordingly, acute and chronic effects of ...

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Chapter4 Teaching monitoring skills Samuel DeMaria Jr., Adam I. Levine, and Yasuharu Okuda Introduction Most medical schools and residency programs do not have a formalized training and assessment program dedicated to the acquisition of skills and knowledge needed for ...