1. Airway techniques
From End of airway technique section:
- 30 “Knowing that we place various airways multiple times
throughout the day, it seems like having a defined number is not
necessary, other than perhaps a FOI, which we do the least amount
of.”
Q3_4 Q141 Natural
airway
Summary of Natural Airway
- Mean: 50.68
- Median: 25
- Range: 5-450
- Standard deviation: 78.68
- Number of zeros: 18
- Number of blanks: 6
FLAGGED:
- 14 “This should be a required skill. The number is suitable for
a medical student anesthesia rotation.”
EXAMPLES:
- 15 “Too routine to require minimums”
- 22 “I am unsure of the utility of this metric. What specific
skill beyond airway management is required? The most common case fitting
this in my current practice would be colonoscopy.”
- 51 “Not sure I recommend general anesthesia without airway
management.”
- 53 “It is a pointless requirement because every resident in
every program will far exceed the number to be competent.”
- 48 “Adding a minimum to something we will naturally be
proficient in adds a burden for trainees because they have to do
additional logging that is not necessary. Four years of anesthesia
residency will expose someone to enough general cases.”
Q3_9 Q306 Mask
ventilation
Summary of Mask ventilation
- Mean: 143.3
- Median: 100
- Range: 10 - 1000
- Standard deviation: 191.59
- Number of zeros: 25
- Number of blanks: 5
EXAMPLES
- 33 “core component of anesthesiology residency; should not be
defined by a minimum expectation number”
- 4 “It’s an assumed part of any general (non-RSI) anesthetic.
Residents accomplish this task roughly a couple of thousand times during
anesthesia residency. If a minimum is required then they will be
expected to capture this task each time and it becomes unnecessary extra
busywork. There is also an issue for the RRC in interpreting residents
who merely stop recording events once the standard is met; for a measure
such as this, which would exceed any minimum by several fold, it
introduces more confounding issues than actual clarification in
standards.”
- 17 “This is a core skill that is covered in the first three
months of training. An attempt does not imply success and does not add
value.”
FLAGGED
- 37 “I think this would be confusing. Is it a case done solely
with mask anesthesia or is it that I was able to mask ventilate the
patient at any point in the case? Since mask ventilation is utilized as
a standard before most airway manipulations, I think there does not need
to be a minimum.”
Q3_5 Q27 Supraglottic
airway
Summary of supraglottic airway
- Mean: 71.5
- Median: 47.5
- Range: 20-500
- Standard deviation: 87.39
- Number of zeros: 17
- Number of blanks: 3
EXAMPLES
- 23 “We should entrust each program to ensure residents have
practice with LMA placement. I do not think it should be up to the ACGME
to track this.”
- 55 “Same as mask ventilation, there are likely hundreds or
thousands of supraglottic airways, far beyond what any rational
requirement would be, and documenting it would be unnecessarily
burdensome”
- 56 “The case requirements are too prescriptive, you have to
assume that residents are getting a wide variety of all airway
techniques.”
FLAGGED
N/A
Q3_6 Q28 Direct
laryngoscopy
Summary of direct laryngoscopy
- Mean: 126.1
- Median: 100
- Range: 20-500
- Standard deviation: 106.597
- Number of zeros: 21
- Number of blanks: 3
EXAMPLES
- 13 “Because the threshold and availability of videolaryngoscopy
varies widely by institution, and the use of video does not in itself
demonstrate lack of competency with direct laryngoscopy.”
- 47 “Covid showed us how quickly we have to adapt our practice
management to accomodate catastrophes and world events (i.e move away
from DL and use move VL during training/practice). I think having a DL
minimum would have put a large undue burden and stress on trainees to
meet standards they would possibly not be able to attain for no fault of
their own. DL is an important skill to maintain and I feel we will
continue to be able to incorporate its teaching without minimums in
anesthesia training just fine.”
- 55 “Direct laryngoscopy v. video laryngoscopy is a rapidly
evolving discussion. Any direct laryngoscopy requirement is likely to be
out of date by the time it’s even published. To me, it’s reminiscent of
ultrasound v landmark for central line placement. It’s no longer logical
to have landmark requirements for central lines.”
FLAGGED
N/A
Q3_7 Q31 Video
laryngoscopy
Summary of video laryngoscopy
- Mean: 80
- Median: 50
- Range: 15-500
- Standard deviation: 90.28
- Number of zeros: 19
- Number of blanks: 3
EXAMPLES
- 3 “Video laryngoscopy is ubiquitous in practice at this point
and it is inconceivable to me that a trainee in anesthesiology would not
exceed any minimum by several orders of magnitude; hence, like masking
and DL above, video scope attempts would be just extra busy
work.”
- 47 “We are now moving toward more use of VL and thus do not feel
a minimum is needed to achieve given trainees will be proficient at this
skill after 4 years of training.”
FLAGGED
N/A
Q3_8 Q33 Fiberoptic
intubation
Summary of Fiberoptic intubation
- Mean: 16.29
- Median: 12.50
- Range: 2-50
- Standard deviation: 11.09
- Number of zeros: 1
- Number of blanks: 1
Q142: Airway management
techniques, any other thoughts
EXAMPLES
- 2”I found it difficult to come up with a number for many of the
above items (attempted mask ventilation, attempted DL, etc) as it is my
estimation we all graduate on the order of thousands.me, I did not get
much experience with fiberoptic intubation and establishing a minimum
would ensure exposure.”
- 8 “This is a really hard section for me to determine. I don’t
feel very strongly about the exact numbers, but I do feel strongly that
mask ventilation, LMAs and direct laryngoscopy need minimum numbers. I
see newer grads having a lot of video laryngoscopy exposure, but in real
life, not every facility has a video scope. Masking, LMA and DL skills
are still very important in many practices. I also see newer folks
intubating everyone for everything. Ensuring broad exposure to LMAs
might help folks be more comfortable using LMAs (but also not getting
themselves into trouble).”
- 14 “I agree with having fiberoptic intubation in a certain
number for case log requirements but do not think mask ventilation,
supraglottic airways, or video laryngoscopy should be included. These
techniques are the basics of anesthesia and should be mastered by all
anesthesiologists. I fear putting a number may give the wrong impression
and the trainees may not take these vital tasks seriously after
attaining the required numbers.”
- 23 “I strongly feel there should not be micro-management of
airway management. This is a hallway of the specialty. We already access
competence on the milestones. The only one that is reasonable is to
ensure practice with fiberoptic management.”
- 29 “For the fiberoptic intubations, residents are not getting as
much experience with these since the regular use to the glide scope and
hence the lower number.number 50 should reflect the number of successful
airway procedures with minimal supervision (ie) resident performed
procedure mostly independently”
- “I do feel that AFOI should be logged by residents. it ever
comes to the point where most people are doing video laryngoscopy rather
that DL, then there should be a case minimum for DL. Analog skills must
be retained, especially b/c of climate change (loss of electrical grid),
supply chain uncertainty, and should they wish to practice in an under
resourced location.”
FLAGGED
- 20 “Consider including invasive airway (ex. cric.)”
- 21 “If it doesn’t complicate it much, I would consider adding a
subsection of location with regards to Airway Management. I’m thinking
of the growing prevalence of NORA sites throughout academic and private
practice and general anesthesia with natural airway in these instances
(IR - airway and PNB, endoscopy, IVF to name a few). This particular
example of NORA and general anesthesia with a natural airway is
important in my opinion.”
- 25 “Awake Fiberoptic Intubation - 5”
- 27 “Our of OR Airways or "The Physiological Difficult
Airway".Sequence InductionIntubation?”
- 31 “Simulation sessions for fiberoptic techniques should be
counted toward this number, not just live patient contact.”
- 37 “I think there should be a way to log both since there can be
procedures where you utilize multiple of these methods… Fiberoptic
utilization has dropped way down with the success and advent of video
laryngoscopy. I wonder if the category minimum should be for indirect
visualization of the vocal cords and track utilization of the fiberoptic
as "use of fiberoptic bronchoscope" which would also include use in
double lumen tubes or intraoperative bronchoscopy for obstruction,
etc.”
- 39 “My numbers are based on a per year case amount. If you have
250 business days and 15 to 20 vacation days during the year my
management for general anesthesia cases is 150 cases which is a bare
minimum for me. The most valuable aspect of any residency is personal
experience in cases. I performed way more cases during my residency but
this was during the time period of 1987 to 1990. Didactic teaching is
very important to me but actual experiences in the OR is what I believe
develops and build residents.”
- 41 “I would ensure that minimums exceed any public numbers for
CRNA/SRNa, AA training.”
- 44 …The other skills that I would consider including would be
lung isolation (DLT / Endobronchial blocker) and Jet
Ventilation.“
- 59 “I would consider adding awake intubations as the above will
not necessarily address topicalization.”
2. Vascular access
People generally thought case minimums were necessary for vascular
access, though people were most split on pulmonary artery catheters,
which some pointed out as “archaic.”
Q190_4 Q191 Arterial lines
(total)
Summary of Arterial lines(total):
- Mean: 41.9
- Median: 40
- Range: 5-100
- Standard deviation: 25.3
- Number of zeros: 8
- Number of blanks: 2
EXAMPLES
- 23 “Vascular access is critical for an anesthesiologist. We can
attest to competency in the milestones, but I do not feel it is
productive to record attempted numbers.”
- 47 “Again, done more than enough times in training, a minimum
isn’t necessary”
Q190_5 Q192 Arterial lines with
ultrasound
Summary of Arterial lines with ultrasound:
- Mean: 23.47
- Median: 20
- Range: 5-100
- Standard deviation: 18.38
- Number of zeros: 9
- Number of blanks: 2
EXAMPLES
- 3 “Many A-lines are typically placed during training. The use of
U/S is helpful, but should not be evaluated as part of ACGME case logs
as it’s not a necessary part of practice.”
- 24 “I believe it’s the arterial line that is important. Whether
or not US is used is not relevant to the skill and practice.”
- 47”We do enough of these in cardiac and other situations
training that a standard is not necessary.”
- “In a typical residency, trainees should perform many more than
what I expect is minimum to become competent (this suggests 40 or so, https://www.sciencedirect.com/science/article/pii/S2256208714000431)”
Q190_6 Q193 Central
lines
Summary of Central lines
- Mean: 24.02
- Median: 20
- Range: 2-50
- Standard deviation: 12.72
- Number of zeros: 4
- Number of blanks: 2
EXAMPLES
- 47 “Given we have to rotate in cardiac, you will place plenty of
lines and gain proficiency there. I think maintaining a minimum amount
of cardiac pump cases can ensure we maintain a CVL minimum. Plus, there
are additional times to place a line that will happen in the 4
years.”
Q190_7 Q194 Pulmonary artery
catheters
Summary of Pulmonary artery catheters
- Mean: 11.16
- Median: 10
- Range: 2-40
- Standard deviation: 7.76
- Number of zeros: 18
- Number of blanks: 4
EXAMPLES
- 9 “As there seems to be a push towards more non-invasive
monitoring techniques, I worry with regards to PA catheters, that we
would be placing catheters in some patients purely for resident numbers
and not for patient benefit”
- 16 “I do not believe that PA catheter placement is essential as
a general anesthesiologist. They are being used less and less
frequently. I do not believe it is essential for graduation.”
- 26 “TEE and other technologies that provide cardiac output
assessment have lead to some centers moving away from PA catheters so
many resident may not ever get the chance to place one. If a resident is
projecting a career with frequent PA catheter use, they will gain the
skill in fellowship. Otherwise, this just may be putting a number to
something most graduates will never use in practice.”
- 40”Some places don’t place PA catheters regularly even for
cardiac surgery. Would be hard to get.”
- 43”Current cardiac anesthesia and ICU literature increasingly
demonstrates a lack of clear outcomes benefit for routine and
perioperative PAC and I think especially with the ABA formally moving to
a certification for Cardiac Anesthesiology, PAC is not particularly
relevant to the general anesthesiologist.”
- 46 “Don’t want to cause patients harm just to get PA lines
placed”
- 60 “There should not be a PA catheter requirement. The data is
not supportive of using this invasive monitor for basic procedures, and
I worry the requirement would disadvantage programs that are not high
volume transplant and VAD centers.”
Q196 Vascular access, other
thoughts
EXAMPLES
- 3 “A-lines represent another technique that may be obviated in
the near future by non-invasive technology. The case log requirements
should, as much as possible, attempt to anticipate trends.”
- 13 “PAC use among institutions varies widely. This is really the
only skill that may need a minimum number to assure some exposure for
each trainee”
- 14 “Vascular access techniques are important and I agree with
making them a part of the case log requirement.”
- 17 “Pulmonary artery catheter placement is rarely done outside
the cardiac OR or CV ICU. Community-based residencies may have fewer
opportunities.”
- 60 “Many residents are extremely dependent on ultrasound. While
this is standard of care of invasive central lines, there should be some
proficiency at placing arterial lines without ultrasound,.”
FLAGGED
- 21 “If it doesn’t make it too difficult, I would also consider
having a subset within each. I personally didn’t place any femoral
central lines or arterial lines during residency which I think would be
helpful (3-5). We didn’t have a heavy penetrating/blunt trauma
experience and I think there is also some utility to learning how to do
blind subclavian central lines if possible (2-3)”
- “I do not believe that 5 PAC placements is sufficient, but I
know that many programs have limited use of PA lines and i would not
want to limit graduation based on this.”
- 25 “Midline placements- 5”
- 28 “Also needed: dialysis/HD line placement attempts (3 is
probably sufficient as these kits are different enough that
familiarization with technique is needed)”
- 37 “I would say that the standard of care has switched to use of
ultrasound in central venous access almost universally so I appreciate
that there is not a category for CVL without ultrasound. Additionally,
this does not take into consideration difficult peripheral IV access
obtained with ultrasound which is a different skill to some extent. I
would consider adding at least 10 PIV with ultrasound guidance or change
the category to "arterial or IV access obtained with
ultrasound".”
- 41 “I would break central line placements in to non internal
jugular (SC/femoral) with a minimum of 5, and internal jugual with a
minimum of 20 total.”
- 44 “Is there also a need to include general IV access?
Proficiency with this skill can translate to dexterity and skills that
apply to all vascular access.”
3. Peripheral nerve blocks
Q197_5 Q199 Upper extremity
blocks
Summary of Upper Extremity Blocks
- Mean: 23.73
- Median: 20
- Range: 10-50
- Standard deviation: 11.83
- Number of zeros: 2
- Number of blanks: 3
EXAMPLES
- 11 “The current requirement of 40 logged peripheral nerve blocks
is adequate. The case log report also lists the site of the block. We do
not have to make it more complicated by adding minimums for each
site.”
- 56 “I think we should require the same total number of blocks
without prescribing exactly how many of each type.”
Q197_6 Q200 Lower extremity
blocks
Summary of Lower extremity blocks
- Mean: 24.55
- Median: 20
- Range: 10-50
- Standard deviation: 12.1
- Number of zeros: 2
- Number of blanks: 3
EXAMPLES
N/A
Q197_7 Q201 Truncal nerve
blocks
Summary of Truncal nerve blocks
- Mean: 19.81
- Median: 20
- Range: 10-50
- Standard deviation: 10.32
- Number of zeros: 3
- Number of blanks: 3
EXAMPLES
- 23 “Unless the graduate is going to be doing an acute pain
fellowship, aside from TAP blocks, I do not think the general
anesthesiologist needs to know how to perform these blocks. They are
rarer and should not be an expected graduation requirement.”
Q197_4 Q198 Attempted peripheral
nerve blocks (total)
Summary of Attempted peripheral nerve blocks
(total)
Participants felt strongly that peripheral nerve blocks should be
included and agreed that an anatomical breakdown was important. But,
participants pointed out that some practices specialize in one
particular region, making some regions difficult for residents to attain
the case requirement.
- Mean: 68.7
- Median: 60
- Range: 10-200
- Standard deviation: 34.77
- Number of zeros: 0
- Number of blanks: 6
Q203 Peripheral Nerve Blocks,
other
EXAMPLES
- 3 “I like this breakdown. Overall, I think this is an important
category to note that anesthesiology is a life-long learning specialty
and blocks, while helpful, are not necessary for most safely delivered
anesthetics. There are fellowships for those who want greater expertise
and CME is extensive in this area beyond graduation.”
- 17 “In our community-based practice, the ability to perform
blocks is highly dependent on the surgeon, which is why the numbers
listed are lower than I would normally consider. In our practice upper
extremity blocks are more challenging. I do think peripheral nerve
catheter placement is a necessary skill for residents to learn, and this
is not a category listed.”
- 26 “I think these numbers should actually be higher. However, I
would guess that the category of nerve blocks has some of the widest
outliers for all case log types among programs, so I am trying to be
mindful of the programs that might not have as robust a pain service
presence.”
- 31 “I feel that each of the general types of blocks should be
represented and have their own minimum to ensure knowledge of relevant
anatomy and block specific considerations. The total number of required
blocks should exceed the addition of each category together to allow for
institutional differences in block culture (i.e one hospital performs
more hip and knee surgery while another performs more shoulder
surgery).”
- 54 “The expansion of applications for regional
anesthesia/analgesia and common incorporation in ERAS pathways justifies
increasing these minimum numbers.”
FLAGGED
- 8 “More definition needed for these numbers. New grads need to
be proficient in interscalene/supraclavicular, popliteal,
femoral/adductor, and TAPS–these cover the majority of surgeries.
Proficiency in these basic blocks should be required–they are used in
nearly every modern anesthesia practice. Other blocks are less widely
used and exposure is acceptable.”
- 9 “Does there need to be a delineation between perineural
catheters and single shot blocks? think our residents should be
competent to perform most basic blocks upon graduation. At a requirement
of only 40 blocks, I would think most would need to pursue fellowship or
additional training to feel comfortable and provide appropriate patient
safety.”
- 14 “Suggestion: Should we think of single shots vs catheters to
include in the total case log?”
- 28 “There are far too many different truncal nerve blocks and
depending on the current du jour block (currently QL it seems), there is
significant heterogeneity in training exposure to the various types.
Would NOT include neuraxial analgesia/anesthesia in these
numbers.”
- 36 “Focus on UE and LE blocks should be on the "workhorse"
blocks such as the supraclavicular and interscalene, sciatic and
adductor canal, and thoracic and abdominal transverse abdominal plane
(TAP) blocks.”
- 41 “With truncal blocks becoming significantly more common, I
think the case log numbers should increase. I would track but not have a
minimum on perineural catheterizations.”
- 44 “I would further delineate truncal nerve blocks. As it is
currently classified above, a resident could achieve all of the truncal
nerve block numbers with TAP blocks. This would not necessarily
translate to Erector spinae or Quadratus lumborum skills /
knowledge.”
4. Neuraxial techniques
Some wanted to differentiate between lumbar and thoracic epidural,
though there was quite an amount of disagreement on this. Because of the
rarity of caudal blocks/some practices not doing them as they only apply
to pediatrics (?) more people said that there shouldn’t be a minimum for
them.
Q204_4 Q205 Epidurals,
INCLUDING combined spinal-epidural and dural puncture
epidural
Summary of Epidurals, INCLUDING combined spinal-epidural and
dural puncture epidural
- Mean: 45.2
- Median: 40
- Range: 10-100
- Standard deviation: 13.47
- Number of zeros: 0
- Number of blanks: 0
Q204_5 Q206 Attempted spinal
block, EXCLUDING combined spinal-epidural
Summary of Attempted spinal block, EXCLUDING combined
spinal-epidural
- Mean: 35.52
- Median: 40
- Range: 5-100
- Standard deviation: 15.94
- Number of zeros: 1
- Number of blanks: 1
EXAMPLES
- 23”A combined procedure still requires understanding of the
science behind spinal and epidural analgesia.”
Q204_9 Q307 Attempted spinal
block, INCLUDING combined spinal-epidural
Summary of Attempted spinal block, INCLUDING combined
spinal-epidural
- Mean: 36.19
- Median: 40
- Range: 10-60
- Standard deviation: 14.3
- Number of zeros: 9
- Number of blanks: 9
EXAMPLES
- 3 “Spinal CSE already captured in epidural (including CSE).
Redundant.”
- 13 “The use of combined spinal-epidural blocks varies by
institutions. The technique in most cases is used in situations in which
epidural alone could be chosen, Combined techniques should be counted as
epidurals.”
- 40 “CSE should be under the epidural heading as epidural
placement is the primary skill used in that procedure”
- 59 “I think if you can do a spinal and an epidural, CSE is
trivial.”
Q204_6 Q207 Attempted Caudal
Blocks
Summary of Attempted Caudal Blocks
- Mean: 8.49
- Median: 5
- Range: 2-40
- Standard deviation: 7.89
- Number of zeros: 20
- Number of blanks: 9
EXAMPLES
- 26 “Caudal blocks are pretty specific to pediatrics. Putting a
random number (say 3-5) doesn’t make me confident the resident would be
competent. Putting a higher number (say 15-20) may be unnecessary if
they’ll never use the skill in practice.”
- 31 “Caudal epidurals are generally done as either a) a procedure
for chronic pain or b) a procedure for surgery in pediatrics. This is
largely surgeon and institution dependent and can be learned in
fellowship training if this skill is desired.”
- 44 “Exposure to caudal blocks would be ideal, but I am not sure
it needs to be an ACGME requirement. I don’t believe it is currently
singled out, and am not sure it is a required skill for a general
anesthesiologist practicing in a community or academic
setting.”
- 60 “This block is not used universally and centers without a
free standing Children’s hospital may be at a disadvantage.”
Q209 Neuroaxial techniques,
other
EXAMPLES
- 54 “I agree with the current standards. The essential skill in
CSE or straight epidural is properly identifying the epidural space with
a Touhy needle. Passing a spinal needle through the Touhy is not a
sufficiently demanding technical skill to be separately assessed as a
minimum experience, and that portion of CSE should not count toward the
minimum for spinal procedures because it distinct from the technical
challenge of identifying the subarachnoid space from the skin with a
more flimsy spinal needle.”
- 51 “1) CSE/DPE should count as epidural only 2) I think there is
value in counting thoracic epidurals as a subset of total.”
- 49 “I think that there should be a minimum number of spinals
excluding CSE as it is a different technique. It’s much less common in
private practice to do a CSE yet in training many residents only do a
few spinals, then struggle to transition. It also lets them get
comfortable with supervised management of a patient should there be a
complication from the spinal vs experiencing that alone post graduation
without ever having become proficient at spinals.”
- 24 “CSE should not count towards spinal requirement. Location of
neuraxial should not be separated in case logs”
- 13 “I don’t think a specific requirement for combined
spinal-epidurals is necessary. As stated, I think they should count
toward the epidural requirement. Location of epidurals do not need
separate tracking.”
FLAGGED
- 53 “I do not think that CSE should contribute to spinal blocks.
They are completely different techniques. CSE should be an epidural
technique.left caudal blank as I think this should be best answered by
peds anesthesia.”
- 43 “I think that there should be separate requirements for
lumbar epidurals (30) and thoracic epidurals (20).” = 32
“Straight Epidurals, Single Shot spinals, and CSEs need to be parsed out
separately. The above language (including/not including) is CONFUSING to
everyone. The 3 are different techniques and should be treated as such.
I could see a resident reliant on CSE to confirm placement not being
comfortable determining loss with a straight epidural. Institutions may
vary in preference for epidurals vs CSE.”
- 17 “A CSE should count as both a spinal and epidural procedure.
I believe we should consider an additional category: ultrasound-guided
neuraxial block. For this I would have a low requirement # like
5.”
- 3”1) See above - CSE should not count towards spinals (but total
spinals should be lower at 20). Simplifies things. 2) Location - not
necessary to track. Thoracic epidurals are placed with lower frequency
than in years past with the advent of erector spinae and paravertebral
blocks.be interesting to consider U/S use for 10 epidurals prior to
graduation? I guess I would favor not including that, but wanted to
bring it up.”
- 9 “I would like to see this system:Neuraxial Blocks: 80- Minimum
Spinal: 40- Minimum Epidural: 40- CSE (this can count towards the 80
neuraxial blocks total, but they don’t need a minimum number of CSEs)do
not believe that a CSE should count as both a spinal and an epidural but
rather one neuraxial”
5. Ultrasound
Assessments
Q210_9 Q216 POCUS exams,
cardiac
Summary of POCUS exams, cardiac
- Mean: 15.27
- Median: 10
- Range: 2-50
- Standard deviation: 11.45
- Number of zeros: 7
- Number of blanks: 9
EXAMPLES
- 23 “cumbersome to track exams to this small a detail.”
- 15 “I don’t think these exams are ubiquitous yet.”
- 11 “We can have a total POCUS exam minimum with listing the site
but there should not be site specific minimums.”
Q210_10 Q217 POCUS exams,
lung
Summary of POCUS exams, lung
- Mean: 12.55
- Median: 10
- Range: 2-50
- Standard deviation: 9.46
- Number of zeros: 8
- Number of blanks: 10
Q210_11 Q218 POCUS exams,
gastric
Summary of POCUS exams, gastric
- Mean: 13.02
- Median: 10
- Range: 2-50
- Standard deviation: 9.57
- Number of zeros: 8
- Number of blanks: 10
Q210_12 Q219 POCUS exams,
FAST
Summary of POCUS exams, FAST
- Mean: 13.29
- Median: 10
- Range: 2-50
- Standard deviation: 9.12
- Number of zeros: 15
- Number of blanks: 11
EXAMPLES
- 1 “Not appropriate for anesthesiologists”
- 9 “Many of the FAST exams are done by Emergency physicians prior
to patients presenting for surgery. There may not be as many
opportunities for this exam outside of that setting that are
specifically done by anesthesia providers.
- 35 “I work at several busy trauma centers in Austin, TX. I have
never been asked to perform a FAST exam myself, as it’s always completed
by either the ER physician or the trauma surgeon. This should be left to
those specialties because our lack of consistency in doing these exams
could lead to false negative calls and perhaps miss early internal
bleeding or bladder rupture.”
- 41 “Not all residents have access to emergency department
assessment of trauma patients and the cases may be prioritized to
ER/surgery or other residents limiting access to this exam.”
Q210_4 Q211 POCUS exams,
total
Summary of POCUS exams, total
- Mean: 43.83
- Median: 30
- Range: 50-200
- Standard deviation: 38.09
- Number of zeros: 4
- Number of blanks: 11
Q210_13 Q220 Transesophageal
echocardiograms
Summary of Transesophageal echocardiograms
- Mean: 15.9
- Median: 10
- Range: 5-100
- Standard deviation: 15.68
- Number of zeros: 12
- Number of blanks: 9
EXAMPLES
- 3 “Fellowship level expertise.”
- 24 “Not a skill required as generalist
anesthesiologist.”
- 40 “TEE is specific to cardiac anesthesiology and would not be a
skill a non-cardiac anesthesiologist would be expected to use (same
rationale for caudal)”
- 43 “TEE is an advanced imaging modality with its own
certification standards as determined by the NBE. In an ideal state, I
think anyone doing a TEE, even for basic resuscitative echo, should be
NBE board certified as determined by existing standards. As this is not
a realistic requirement for the majority of programs and the ABA now has
a separate board certification for cardiac, I think TEE is inappropriate
in the hands of a non-NBE certified non-cardiac
anesthesiologist.”
Q214, Ultrasound
assessments, other
People generally see POCUS as the future of the field and necessary
to have minimums. Some discussed not breaking the exams down into
categories, or mentioned “TEE.” Some noted that some programs would be
unable to reach the requirements.
EXAMPLES
- 3 “POCUS is evolving. I would favor allowing programs to create
their own content until the data is more robust in suggesting improved
outcomes.”
- 8 “I’ve seen POCUS used mostly in emergencies and to supplement
complex decision making. I don’t have feelings on specific numbers, but
I do think expsoure to all in important. New grads will likely be
teaching their senior partners these techniques as we see them
increasing incorporated into practice. For TEE- I’d say 20 full and 20
select exam. We need exposure enough for basic evaluation
intraoperatively”
- 17 “In our practice, we have residents complete ASA POCUS
Certification. FAST exams are difficult to obtain in our community-based
program.”
- 27 “I would use the ASA certification for POCUS as the minimum
number required.”
- 32 “Given that POCUS is an expectation for graduation and an
essential skill for OSCE and board certification, establishing minimums
may encourage leadership in residencies without robust pocus programs to
allocate resources into such.”
- 37 “While I think it is worthwhile to perhaps create a minimum
for all POCUS exams to push the field to expand their practice, I think
that subcategorizing those minimums puts many programs at risk. The fact
is that POCUS is not the standard practice in the OR each and every day
across the country. While able to be utilized in the ICU, until POCUS is
more standard of practice and clinically proven to actually improve care
and diagnosis, requiring ACGME minimums is an reach.”
FLAGGED
- 23 “I do think POCUS exams should be included, however, tracking
all the sub-types is cumbersome. I think there should be a basic
requirement of 10, where the instructions are they should include a
variety of cardiac, lung, gastric and FAST exams.”
- “I think we should specify that exams performed in an
educational setting, including those performed on mannequins, count
towards the minimum requirements.”
- 34 “For TEE, the views needed should be mid-esophageal 4-chamber
view, mid-esophageal long-axis view, and the trans-gastric
view.”