Article

2007 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on Perioperative Cardiac Evaluation Are Usually Incorrectly Applied by Anesthesiology Residents Evaluating Simulated Patients

Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL, USA.
Anesthesia and analgesia (Impact Factor: 3.47). 03/2011; 112(4):940-9. DOI: 10.1213/ANE.0b013e31820a1457
Source: PubMed

ABSTRACT

The 2007 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the accepted standard for perioperative cardiac evaluation. Anesthesiology training programs are required to teach these algorithms. We estimated the percentage of residents nationwide who correctly applied suggested testing algorithms from the ACC/AHA guidelines when they evaluated simulated patients in common clinical scenarios.
Anesthesiology resident volunteers at 24 training programs were presented with 6 scenarios characterized by surgical procedure, patient's risk factors, and patient's functional capacity. Scenarios and 5 possible recommendations per scenario were both presented in randomized orders. Senior anesthesiologists at 24 different United States training programs along with the first author of the 2007 ACC/AHA guidelines validated the appropriate recommendation to this web-based survey before distribution.
The 548 resident participants, representing 12% of anesthesiology trainees in the United States, included 48 PGY-1s (preliminary year before anesthesia training), 166 Clinical Anesthesia Year 1 (CA-1) residents, 161 CA-2s, and 173 CA-3s. For patients with an active cardiac condition, the upper 95% confidence bound for the percent of residents who recommended evaluations consistent with the guidelines was 78%. However, for the remaining 5 scenarios, the upper 95% confidence bound for the percent of residents with an appropriate recommendation was 46%.
The results show that fewer than half of anesthesiology residents nationwide correctly demonstrate the approach considered the standard of care for preoperative cardiac evaluation. Further study is necessary to elucidate the correct intervention(s), such as use of decision support tools, increased clarity of guidelines for routine use, adjustment in educational programs, and/or greater familiarity of responsible faculty with the material.

1 Follower
 · 
4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a "research gap" where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.
    No preview · Article · Dec 2011 · Canadian Anaesthetists? Society Journal
  • [Show abstract] [Hide abstract]
    ABSTRACT: The preoperative evaluation is vital in providing information to reduce the risks associated with the anesthesia and surgery and improve the quality of care. In the VA Nebraska-Western Iowa Health Care System, we introduced a computer-based cardiac algorithm as part of the preoperative evaluation software. Following the pre-op examination and use of the algorithm, the provider completed a survey regarding their perceived usefulness of the algorithm software. The survey results showed that effective preoperative evaluation can be performed using a preoperative evaluation clinic, users are receptive to the computer-based format and, in most cases, prefer to have the algorithm software available for use in preoperative assessment.
    No preview · Article · Jan 2012 · Studies in health technology and informatics
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine if practicing anesthesiologists recommend preoperative evaluations consistent with the 2007 ACC/AHA guidelines on perioperative care. Survey instrument. Academic medical center. ASA membership. In this Web-based survey, participants were presented with 6 clinical scenarios characterized by surgical procedure and the patient's clinical condition (ie, clinical risk factors and functional capacity). Scenarios and possible recommendations were presented randomly. Participants were asked to select the recommendation they considered to be most consistent with the Guidelines. The percentage of participants selecting the recommendation most consistent with the 2007 Guidelines was recorded. Of the 22,504 actively practicing members of the ASA who were sent a survey, 1,595 actively practicing self-selected anesthesiologists responded. For one of 6 scenarios, patients with an active cardiac condition, the upper 95% confidence bound for the percent selecting a recommendation consistent with the Guidelines was 82%. For the remaining 5 scenarios, the upper 95% confidence bound for the percent of anesthesiologists with an appropriate recommendation did not exceed 40%. With the exception of the scenario describing a patient with an active cardiac condition, respondents were more likely to provide recommendations consistent with the Guidelines if they had been in practice less than 5 years or worked in a teaching environment. When evaluating simulated patients, practicing anesthesiologists who are ASA members did not recommend preoperative evaluations that were consistent with the 2007 ACC/AHA Guidelines.
    No preview · Article · Jun 2012 · Journal of clinical anesthesia
Show more