Ask Alex

Q&A with Stanford Anesthesia's Residency Director

Update on some residency activities!

Posted 9:10 PM, December 17, 2014, by amaca

Faculty advisor meeting twice a year
An updated medhub form (https://stanford.medhub.com/functions/evaluations/index.mh?p=anes) has been created to document this mtg. The new Faculty Advisor job description is in Appendix A.

Chief Resident QI project
The GME Chief resident committee has sharps/exposure prevention as the QI project for the year. Suturing needles account for the majority of sharps exposures across the institution.
The Anesthesia Chief Residents surveyed the housestaff to better understand the problem. Suggestions mentioned include:
• More blunt needles for drawing up meds
• More sharps containers on wheels
• Getting rid of glass vials
• Self-capping TB needles for local anesthetic administration
• Anesthesia safe zone – a mayo stand dedicated with anesthesia line placement
These data are to be presented to GME Chief council with further system changes in hospital and OR to be discussed.

Resident Clinical Dashboard
Dr. Kadry has been working on creating a dashboard of data extracted from epic for residents to use that includes clinical data that housetaff can use to change and improve their practice. The data will also include procedures and cases performed. Residents in the committee agreed that these report cards are beneficial (great tool to discuss with advisor). Would like to do a trial run. The goal is to have report sent to house staff weekly starting in January.

Pediatric Anesthesia Rotation Update
Dr. Julie Mendoza is new rotation director for pediatric anesthesia. Orientation is held on the first day of rotation. Milestones are being updated with Dr. Adriano with special emphasis on delineating junior from senior resident milestones. The senior residents are asking for opportunity to do Peds before graduation so some senior rotation 4 week blocks may be broken into 2 week blocks.

Milestones
Dr. Adriano is working with rotation directors on milestones (http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/AnesthesiologyMilestones.pdf) as well as with their use by the Clinical Competence Committee. Levels of scoring (1-5) were reviewed as different from prior resident evaluation forms. The milestones assessments for each rotation may be modified by each rotation director to be more focused.

VA ICU
Dr. Brun updated the committee on the VA ICU rotation. Anesthesia are paired with an intern to provide supervisory and teaching opportunity. There are daily 1 hour lectures. Dr. Brun and ICU team are updating learning goals and objectives and milestones assessment instrument and aim to make that available to residents before the rotation.

New Program: the Stanford Anesthesia Innovation Lab (SAIL)
Dr. Barrett Larson CA3 is creating a new program which he will direct as faculty beginning next yr. The mission of SAIL is to drive medical device innovation and education in the Department of Anesthesiology. The goal is to create a community where innovation can flourish. The department has provided some seed funding.

Anatomy Sessions for Residents
Dr. Outterson presented a plan for use of prosection cadavers during lecture time so that residents can work on cadavers and learn anatomy especially for nerve blocks. She is working with Melissa Cuen to schedule this.

UC Irvine Airway Teaching Course
CA2s Lindsay Borg, Ann Ng, and Louise Wen and Fellow Tammy Wang were invited to teach an advanced airway workshop at the California Anesthesiology Medical Student Symposium hosted by UC Irvine. Kudos for a wonderful job. Residency fair was held as well.

Feedback tool
Dr. Tanaka has been working on mechanisms to increase feedback to residents by faculty. An easy medhub link is available at https://stanford.medhub.com/functions/evaluations/index.mh?p=anes
A trial pilot in the MSD was successful (one resident had 12 feedback entries) but it requires both attendings and residents to initiate feedback discussion and documentation. One way to start is to state that the following conversation is meant to be feedback.
The faculty can ask for the resident’s self-assessment of performance.
The faculty can tell the resident what they observed. “I saw/noticed/ observed…” and move on to “I am concerned/impressed…”
The faculty can inquire: “What was on your mind at the time?” “I wonder how you saw it?” and respond to the resident’s self-assessment and then formulate teaching point based on response to inquiry. Ask for resident’s understanding and strategies for improvement (action plan). Give suggestions, offer alternatives.

Libero lecture offered 3 times a day
A survey was distributed to the residents by CA2s Lena Scotto and Lindsay Borg to help assess the lecture series. The impression is that the lecture series is a valuable tool to help with preparing for the boards (has lessened study time on some topics) and want to make content more easily accessible on website on Ether by AIM Lab with slides and podcasts. Proposal to link each Libero lecture to keyword (title of Libero has to be the keyword). The keywords will be alphabetized. Clicking on each keyword will open a drop down menu with a link to the pdf of the PowerPoint presentation, an MP3 recording of the lecture (possible, need to pilot to see if it's going to be used), 2-3 flash cards (future addition).

Update Society of Academic Anesthesiology Association meeting
Dr. Adriano updated the committee of the SAAA in Chicago. A couple of items are that the BASIC Exam is now scheduled for Friday, June 12, and Saturday, June 13, per requests from Program Directors to move the original July dates forward to avoid creating scheduling challenges. Also, the regional anesthesia fellowship is likely to become an ACGME accredited fellowship.

Lead Apron QI Final Report
CA3 Dr. Wang summarized that an initial survey demonstrated that there was a need for more lead aprons (particularly in the Stanford MOR) and radiation safety education. With the support of Stanford OR management, many of the previously locked aprons were unlocked to increase availability. Also, the OR administration purchased 5 sets of small size aprons for anesthesiology use which are kept by the anesthesia techs. Dr. Wang also wrote a review article and designed a Powerpoint presentation on radiation safety which Tanya Travkina is incorporating into the EP rotation curriculum. These educational materials were distributed to the residents, and prelim results from a final survey show that residents feel that the lead apron situation has improved.

Chronic Pain rotation
Dr. Singh proposed and will be trialing a 1255-110 pm teaching session for the A2 faculty (faculty assigned to the resident in the chronic pain clinic) with protected time. She will report back in 6 months to see impact of this change.

Acute Pain Call
Currently the 2 acute and 2 chronic pain residents take q4 call from home on pain patients. There is an interest in having this resident be in house and with a full day after call to be able to respond to inpatient needs more quickly. This requires a call room which may not be readily available so will work with hospital to see if there are any options. Other resident call combinations are being studied. Also, a second NP is being hired to help with the work on the acute pain service.

Conference attendance
One of the metrics used for milestones is conference attendance. The committee discussed what an acceptable level of attendance would be given vacations, day after calls, etc and the group recommend 50% of grand rounds and 70% of the weekday didactic lectures as baseline minimum expectations for the residents in the MSD rotation. This will be measured starting next month.


Appendix A

Faculty Advisor Job Description
The faculty advisors are a core group of educators from the department faculty responsible for counseling and guiding the resident through residency processes and learning objectives.

Each faculty advisor has one resident per year (PGY 2, 3 and 4) of training. Having 3 resident advisees per attending allows the faculty to more easily gain advising expertise including evaluating milestone progression.

A meeting between advisor and resident occurs at least twice a year with completion of the online Medhub instrument (https://stanford.medhub.com/functions/evaluations/index.mh?p=anes) by the faculty advisor. A best practice is to send this Medhub instrument to the resident a week before the meeting so the resident can prepare for the meeting with their faculty advisor.

The meeting that occurs between the faculty advisor and resident advisee serves administratively as the Semi-Annual Meeting with Program Director. With more than 80 housestaff in the Stanford Anesthesia residency more individualized advising for each resident is possible from the faculty advisors.

Any resident is also free to ask to meet with any of the program directors at any time, and can ask to change faculty advisor if needed. A resident can have multiple faculty mentors, but a resident shall have a single faculty advisor at any one time.

The job description of the faculty advisor includes:
Listener: please meet with each resident advisee at least twice a year to listen to any personal or professional concerns that residents have and to provide advice and guidance.
Goal setter: please assist advisees in creating an individualized learning plan, including career goals, self-identified strengths and weaknesses, and explicit training objectives. For each objective, identify resources to help the resident and ideally determine how the resident will measure achievement. This goal setting function includes encouragement with respect to scholarship opportunities including research and QI. The Medhub form helps document and keep track of this.
Residency planner: please work with advisees to plan educational activities related to specific learning needs (for example, a global health experience). Please make sure the resident is on track to complete all required rotations and surpass the minimum case requirements. Please promote self-directed learning and personalize the educational experience of trainees. This includes linking advisees with mentors (e.g., for planning for postresidency career).
Evaluator and problem solver: examine monthly evaluations on the resident via medhub and review with residents to assess the trainee's educational progress and provide insights and feedback. If there are informal comments from other faculty about the resident, these will be provided to the advisor to discuss with the resident. Advisors assist trainees in identifying strategies for addressing any problem areas (as might be identified in milestones assessments by each rotation). Advisors, on occasion, need to work with the clinical competence committee and program director on corrective action or remediation plans. Please provide recognition for work well done by the resident.
Collaborator and scholar: please work with other faculty advisors work to enhance all aspects of the residency. This includes working with the education committee on curriculum, assessment, and teaching methods. Please also disseminate any innovations you develop through local, regional, and national meetings such as the SEA or ASA.

Advisors are liaisons to the residency program director. Faculty advisor is a way to join the residency administrative team and build experience in advising.
Characteristics of an effective advisor include:
• honesty, integrity, enthusiasm, and patience
• open-minded
• a resident advocate
• have the respect of other residents and faculty
• possess a high level of emotional intelligence and well-developed organizational and time management skills

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