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Development of a Milestones Based Obstetric Anesthesia Curriculum with Assessment Tools
Abstract Number: F-43
Abstract Type: Original Research
Obstetric (OB) anesthesia is part of the core requirements of anesthesia residency set by the Accreditation Council for Graduate Medical Education (ACGME).1 The Milestones Framework is a required assessment process for evaluation of residents in an ACGME certified program. These assess the resident’s skills, attitudes, and knowledge by providing benchmarks for each level of training. To properly evaluate residents, objective measures of performance are required.2 There are few validated tools to assess performance for OB anesthesia. This abstract describes the process of changing rotation objectives and creation of tools to measure how well the objectives are met.
Existing first OB anesthesia clinical rotation objectives were revised to a list of 21 objectives: 5 Patient care, 7 Medical knowledge, 2 Practice-based Learning & improvement, 2 Systems-based Practice, 3 Professionalism, and 2 Interpersonal & Communication Skills. Each objective was linked to one or more assessment tools, which were developed by the authors by adapting previously validated tools in the regional anesthesia literature or revising questionnaires in use to reflect the Milestones framework. These assessments were then utilized to determine each resident’s achievements of Milestones. Task-specific assessment tools include: Pre-anesthetic Interview and Informed Consent Checklist, Epidural Labor Management Evaluation, Spinal Anesthesia for Cesarean, and Epidural Insertion Checklist3. Global evaluation tools include streamlined end-of-rotation evaluation, pre/post-test, and 360 Degree Evaluation for OB/GYN nurses, residents, and attendings. New learning opportunities include Simulation of General Anesthesia for Cesarean, Case-based Discussion Checklist, and Challenging Case Self-assessment Write-up. The number of assessments for each objective and tool were determined. The new curriculum was implemented with the CA-1 residents in September 2014.
Development of meaningful rotation objectives and assessment tools for OB anesthesia are critical to facilitate resident development of skills necessary to become competent. Our evaluation system is designed such that each task-specific assessment is done at the time of procedure and discussed with the resident to provide immediate feedback. This allows us to identify residents with deficiencies and develop action plans to address problems. As the residents progress, advanced rotation objectives will reflect higher levels of competence, with development of new tools that focus on critical thinking skills.
2. Ebert T, Fox C. Competency-based Education in Anesthesiology: History and Challenges. Anesthesiology 2014;120(1):24-31
3. Friedman Z, et al. Objective assessment of manual skills and proficiency in performing epidural anesthesia-video assisted validation.Reg Anesth Pain Med 2006; 31(4):304-10