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Previous studies have identified an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk patients. The aim of this study was to update these trends with the most recent years of data. We used Medicare and commercial claims data from 2010 to 2013 to identify GI procedures and anesthesia services based on CPT codes, which were linked together using patient identifiers and dates of service. We defined low-risk patients as those who were classified as ASA (American Society of Anesthesiologists) physical status class I or II. For those patients without an ASA class listed on the claim, we used a prediction algorithm to impute an ASA physical status. Over 6.6 million patients in our sample had a GI procedure between 2010 and 2013. GI procedures involving anesthesia service accounted for 33.7% in 2010 and 47.6% in 2013 in Medicare patients, and 38.3% in 2010 and 53.0% in 2013 in commercially insured patients. Overall, as more patients used anesthesia services, total anesthesia service use in low-risk patients increased 14%, from 27,191 to 33,181 per million Medicare enrollees. Similarly, we observed a nearly identical uptick in commercially insured patients from 15,871 to 22,247 per million, an increase of almost 15%. During 2010-2013, spending associated with anesthesia services in low-risk patients increased from US$3.14 million to US$3.45 million per million Medicare enrollees and from US$7.69 million to US$10.66 million per million commercially insured patients. During 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.

Certified registered nurse anesthetists (CRNAs) can evaluate anesthesiologists with whom they work clinically using a psychometrically reliable and valid scale. Use of such a scale to evaluate performance depends on knowing thresholds for minimum and ideal anesthesiologist performance. Cohort study. One large teaching hospital. 379 CRNA evaluations of anesthesiologists' performance, and associated thresholds for minimum and ideal scores, performed over 15 weeks. The anesthesiologists' performance score was less than the CRNA's minimum score for the evaluation (i.e., too little anesthesiologist participation in patient care) for 25% (95) of the CRNA evaluations. The score was greater than the CRNA's ideal score for the evaluation (i.e., excessive participation in patient care) for 28% (106) of evaluations. Anesthesiologists' performance was assessed as not meeting expectations 53% of the time. Even if every anesthesiologist performed consistently at the same level, ≥50% of CRNAs would have been dissatisfied (187), not significantly different from observed (P = 0.34). Consistent results were found when the unit of analysis was individual CRNA. Among the 22 CRNAs who provided ≥10 evaluations, the median level of anesthesiologist performance was either less than the individual CRNA's mean minimum acceptable performance (8/22) or greater than their mean ideal performance (9/22), with overall dissatisfaction, 77%. Among the CRNA-anesthesiologist pairs working together, most did so less than once per month (76%, 1242/1635). In this single-center study at a large teaching hospital, broad heterogeneity among CRNAs in their expectations for anesthesiologist collaborative practice was found. Anesthesiologists adjusting their behavior based on individual CRNA preferences was impractical because specific CRNA-anesthesiologist pairs work together infrequently. Future studies should examine consistency among organizations and whether changes in expectations, and perhaps less dissatisfaction, can be achieved by communication of results for CRNA preferences for anesthesiologists' participation in patient care and discussing shared expectations among the CRNAs and anesthesiologists. •During evaluation of anesthesiologists’ performance, nurse anesthetists judged too little participation in patient care for 1/4 evaluations.•During evaluation of anesthesiologists’ performance, nurse anesthetists judged excessive participation in patient care for 1/4 of evaluations.•No systematic change in anesthesiologists’ performance department wide could reduce the 50% dissatisfaction.

Background Ethiopia drastically increased the anesthesia workforce density by training ‘associate clinician anesthetists’ as a task-shifting and sharing strategy. However, there were growing concerns about educational quality and patient safety. Accordingly, the Ministry of Health introduced the anesthetist national licensing examination (NLE) to assure the quality of education. However, empirical evidence is scarce to support or refute the overall impact of NLEs, which are relatively costly for low- and middle-income settings. Therefore, this study aimed to explore the impact of introducing NLE on anesthetists’ education in Ethiopia. Methods We conducted a qualitative study using a constructivist grounded theory approach. Data were prospectively collected from ten anesthetist teaching institutions. Fifteen in-depth interviews were conducted with instructors and academic leaders, and six focus groups were held with students and recently tested anesthetists. Additional data were gathered by analyzing relevant documents, including versions of curricula, academic committee minutes, program quality review reports, and faculty appraisal reports. Interviews and group discussions were audiotaped, transcribed verbatim and analyzed using Atlas.ti 9 software. Results Both faculty and students demonstrated positive attitudes toward the NLE. Student motivation, faculty performance, and curriculum strengthening were the three primary changes that emerged, resulting in three subsequent spin-offs on assessment, learning, and quality management practices. Academic leaders’ dedication to evaluating examination data and turning these into action led to changes that improved education quality. Increased accountability, engagement, and collaboration were the predominant factors facilitating change. Conclusion Our study indicates that the Ethiopian NLE has prompted anesthesia teaching institutions to improve their teaching, learning, and assessment practices. However, more work is required to improve exam acceptability among stakeholders and drive broader changes.

Background Performing CPR (Cardiopulmonary Resuscitation) is an extremely intricate skill whose success depends largely on the level of knowledge and skill of Anesthesiology students. Therefore, this research was conducted to compare the effect of the scenario-based training method as opposed to video training method on nurse anesthesia students’ BLS (Basic Life Support) knowledge and skills. Methods This randomized quasi-experimental study involved 45 nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran in 2022–2023. The practical room of the university formed the research environment. The participants were randomly divided into three groups of scenario-based training, video training, and control. Data were collected by a knowledge questionnaire and a BLS skill assessment checklist before and after the intervention. Results There was a significant difference between the students’ scores of BLS knowledge and skill before and after the educational intervention in both SG (scenario group) ( p  < 0.001) and VG (video group) ( p  = 0.008) ( p  < 0.001). However, no significant difference was observed in this regard in the CG (control group) ( p  = 0.37) ( p  = 0.16). Also, the mean scores of BLS knowledge and skills in the SG were higher than those in the VG ( p  < 0.001). Conclusion Given the beneficial impact of scenario-based education on fostering active participation, critical thinking, utilization of intellectual abilities, and learner creativity, it appears that this approach holds an advantage over video training, particularly when it comes to teaching crucial subjects like Basic Life Support.

Proficiency in epidural placement remains a challenging skill for anesthesia providers, requiring the ability to discern loss of resistance (LOR) when entering the epidural space. Current educational manikins lack the tactile feedback required for realistic epidural training. This descriptive pilot study aimed to compare an porcine spine model with the M43B manikin model for simulation of clinical epidural placement. Expert anesthesia providers (n = 10) evaluated physical characteristics of each model using a survey comprised of a visual analog scale (0-100) and qualitative open-ended questions. Continuous data were analyzed using paired two-tailed Student's t tests, while qualitative open-ended narrative responses were reported by response frequency. Epidural simulation with the porcine spine demonstrated significantly higher clinical similarity scores ( < .001) for ligamentum flavum feel (85 ± 4.5 vs. 32 ± 8.1), LOR (93.5 ± 3.0 vs. 42.5 ± 10.7), catheter insertion (92.3 ± 3.9 vs. 48.8 ± 8.0), and novice training utility (92.5 ± 3.3 vs. 41.5 ± 7.7), while landmark identification (iliac crest/spinous processes) was comparable between models. Providers unanimously preferred the porcine model for epidural simulation. Simulation using an porcine spine model enhances the realism of epidural training and underscores the importance of utilizing clinically relevant models for anesthesia procedural skill acquisition and maintenance.

Non-technical skills are a fundamental component for successful anesthesia practice and have been demonstrated to reduce medical errors and adverse events [5]. Despite the recognized importance of non-technical skills, a systematic review showed there is wide variability in leadership and emotional intelligence development and education among physicians in the US [6]. With the shift toward competency-based education, non-technical skills are becoming a more common component of training.

Background Several Japanese educational institutions have begun to train nurse anesthetists. They manage the patient consistently from pre-operation to post-operation in collaboration with the anesthesiologist. This has helped improve the quality of anesthetic management in an anesthesiologist shortage environment in Japan. However, no studies have examined the quality of anesthetic management by nurses worldwide. Therefore, this study investigated the quality of anesthesia among novice anesthesiology residents and nurse anesthetists, focusing on blood pressure control. Methods This study included adult patients undergoing breast surgery. Nurse anesthetists or anesthesiology residents oversaw general anesthesia. Intraoperative electronic medical records were used to compare the general anesthesia management of nurses and residents. The primary outcome was the sum of the duration during which the mean blood pressure was < 65 mmHg. This was quantified as a percentage of the total anesthesia time (time under mean 65 mmHg: TUm65). Independent variables included patient demographic characteristics, clinical information, the percentage decrease from baseline in the lowest mean blood pressure during anesthesia, and the hourly infusion volume. Results No significant difference was observed in the TUm65 (nurse anesthetists vs. anesthesiology residents: median [IQR] 11.3% [3.3–20.7] vs. 18.1% [5.3–24.0], p  = 0.078). No significant differences were noted between nurses and residents concerning the other outcomes. Conclusion No significant differences were observed in the intraoperative blood pressure control between the nurse anesthetists and anesthesia residents.

Anesthesiologists can provide psychometrically reliable daily evaluations of certified registered nurse anesthetist (CRNA) work habits for purposes of the mandatory ongoing professional practice evaluation (OPPE). Our goal was to evaluate the validity of assessing CRNA work habits. Observational study. Large teaching hospital. N=77 anesthesiologists evaluated work habits of N=67 CRNAs. The non-technical attribute of work habits was measured on a 6-item scale (e.g., 1=“Only assumed responsibility when forced to, and failed to follow through consistently” versus 5=“Consistently identified tasks and completed them efficiently and thoroughly”). One year of scores were used to assess validity. Each daily evaluation could also be accompanied by a written comment. Content analysis of comments was performed using two years of data. Statistical analyses were performed using mixed effects logistic regression, treating each anesthesiologist as a fixed effect to compensate for the leniency of their ratings. The N=77 anesthesiologists' response rate was 97.3%, obtained at a mean 2.93days after the request. The internal consistency of the scale was large: Cronbach's alpha 0.952. Controlling the false discovery rate at 5.0%, among the 67 CRNAs, 8 were significantly below average (each P≤0.0048) and 6 were above average (each P≤0.0018). During the 6months after CRNAs knew that their work habits scores would be used for OPPE, there were significant increases in the scores compared with the preceding 6months (odds ratio 1.93, P<0.0001). Greater CRNA's qualitative annual evaluation scores made by the chief CRNA, without knowledge of the work habit scores or comments, were associated with greater odds of the CRNA's leniency-adjusted work habit scores equaling 5.00 (odds ratio 1.53, P=0.0004). Comments of negative sentiment made by the anesthesiologists were associated with greater odds of the leniency-adjusted work habit scores being <5.00 (odds ratio 54.5, P<0.0001). Even though the anesthesiologists were already providing information about work habits using the work habits scale, approximately half the comments of negative sentiment included the theme of work habits (92/153, 60.1%). Reporting OPPE metrics are mandatory for the maintenance of clinical privileges of anesthesia practitioners in the USA. Basing such peer review on work habits can be quantitative, psychometrically reliable, and valid. •Peer review of certified registered nurse anesthetists should be quantitative, psychometrically reliable, and valid.•Work habits were measured on a 6 item scale.•Greater annual evaluation scores were associated with higher work habits scores.•Comments with negative sentiment were associated with lower work habit scores.•Comments with negative sentiment often included the theme of work habits.•Results show validity of using a work habits scale for daily evaluation of nurse anesthetists' clinical performance.