COMMENTARY

The Competent Anesthesiologist

Alex Macario, MD, MBA

Disclosures

June 11, 2013

"GIOSAT": A Tool to Assess CanMEDS Competencies During Simulated Crises

Neira VM, Bould MD, Nakajima A, et al
Can J Anaesth. 2013;60:280-289

Study Summary

The goal of this study was to develop a measurement tool to assess clinical performance of a resident in a simulator. The measurement tool is a list of 14 items that are components of clinical care, and a score from 1 (very poor) to 6 (very good) is given for each item. Defining the list of items that would be scored (Table) was finalized after a literature review and formal discussion among the study authors.

Table. Competencies to Assess Anesthesiologist Clinical Performance in Simulator

Intrinsic Competencies
Communicator Clear/concise, verbal and nonverbal, closed loop technique, share information -- "think aloud," orient new members, exchange information, listen to team input.
Collaborator Should stay calm and in control during crisis, demonstrate authority and leadership or respond appropriately to leadership.
Clear understanding of his/her roles within the team. Support each other.
Manager Formulate a plan in advance; establish priorities with appropriate use of key resources.
Ask for help appropriately.
Professional Maintain standards of care, mutual respect, ethics and legal codes.
Team members refer to established protocols.
Disagreements or conflicts among team members are addressed.
Health advocate Attention to patient/team safety risks and needs.
Scholar Teaching and demonstrating reflective learning.
Application and translation of medical knowledge beyond algorithms (eg, critically evaluate information and its sources; apply this appropriately to practice decisions).
Medical Expert Competencies
Situation awareness Attention/vigilance. Frequent scan of environment (monitors).
Anticipate likely events.
Medical history Gather information, medical history.
Examine patient/equipment Quick problem-directed physical exam.
Quick check of equipment/monitors.
Diagnosis/differentials Recognize the problem and communicate.
Consider differentials.
Confirmation/investigations Order and interpret appropriately pertinent labs/images/monitors.
Medical therapeutic Compensatory and specific agent or medication, time, dose, route, and response.
May use checklists and reminders.
Procedure therapeutic Compensatory and specific procedure/intervention, time, technique, and response.
Deal with changing situations Reassess/re-evaluate. Recognize changes.

 

In the study, 4 faculty members reviewed a videotape of 50 residents managing 1 of 2 intraoperative advanced cardiac life support scenarios lasting 5 minutes: ventricular fibrillation due to hyperkalemia or pulseless ventricular tachycardia secondary to myocardial infarction.

The 4 trained raters scored residents and items generally in agreement, and the most senior residents received higher scores overall than the least experienced junior residents. However, the scorers found it challenging to properly measure some of the intrinsic competencies such as professionalism.

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