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The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology present an updated report of the Practice Guidelines for Obstetric Anesthesia. Supplemental Digital Content is available in the text.

BackgroundFaculty turnover threatens the research, teaching and clinical missions of medical schools. We measured early attrition among newly-hired medical school faculty and identified personal and institutional factors associated with early attrition.MethodsThis retrospective cohort study identified faculty hired during the 2005–2006 academic year at one school. Three-year attrition rates were measured. A 40-question electronic survey measured demographics, career satisfaction, faculty responsibilities, institutional/departmental support, and reasons for resignation. Odds ratios (ORs) and 95 percent confidence intervals (95% CI) identified variables associated with early attrition.ResultsOf 139 faculty, 34% (95% CI = 26-42%) resigned within three years of hire. Attrition was associated with: perceived failure of the Department Chair to foster a climate of teaching, research, and service (OR = 6.03; 95% CI: 1.84, 19.69), inclusiveness, respect, and open communication (OR = 3.21; 95% CI: 1.04, 9.98). Lack of professional development of the faculty member (OR = 3.84; 95% CI: 1.25, 11.81); institutional recognition and support for excellence in teaching (OR = 2.96; 95% CI: 0.78, 11.19) and clinical care (OR = 3.87; 95% CI: 1.04, 14.41); and >50% of professional time devoted to patient care (OR = 3.93; 95% CI: 1.29, 11.93) predicted attrition. Gender, race, ethnicity, academic degree, department type and tenure status did not predict early attrition. Of still-active faculty, an additional 27 (48.2%, 95% CI: 35.8, 61.0) reported considering resignation within the 5 years.ConclusionsIn this pilot study, one-third of new faculty resigned within 3 years of hire. Greater awareness of predictors of early attrition may help schools identify threats to faculty career satisfaction and retention.

Since 2001, there have been significant changes in how responding hospitals provide obstetric anesthesia care and staff the labor and delivery ward. Obstetric anesthesia surveys, updated every 10 years, continue to provide information about changes in obstetric anesthesia practice.

Practice Guidelines for Obstetric Anesthesia An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia* PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert opinion, open forum commentary, and clinical feasibility data. This update includes data published since the "Practice Guidelines for Obstetrical Anesthesia" were adopted by the American Society of Anesthesiologists in 1998; it also includes data and recommendations for a wider range of techniques than was previously addressed. Methodology A. Definition of Perioperative Obstetric Anesthesia For the purposes of these Guidelines, obstetric anesthesia refers to peripartum anesthetic and analgesic activities performed during labor and vaginal delivery, cesarean delivery, removal of retained placenta, and postpartum tubal ligation. B. Purposes of the Guidelines The purposes of these Guidelines are to enhance the quality of anesthetic care for obstetric patients, improve patient safety by reducing the incidence and severity of anesthesia-related complications, and increase patient satisfaction. C. Focus These Guidelines focus on the anesthetic management of pregnant patients during labor, nonoperative delivery, operative delivery, and selected aspects of postpartum care and analgesia (i.e., neuraxial opioids for postpartum analgesia after neuraxial anesthesia for cesarean delivery). The intended patient population includes, but is not limited to, intrapartum and postpartum patients with uncomplicated pregnancies or with common obstetric problems. The Guidelines do not apply to patients undergoing surgery during pregnancy, gynecologic patients, or parturients with chronic medical disease (e.g., severe cardiac, renal, or neurologic disease). In addition, these Guidelines do not address (1) postpartum analgesia for vaginal delivery, (2) analgesia after tubal ligation, or (3) postoperative analgesia after general anesthesia (GA) for cesarean delivery.

Background Despite the known benefits of active learning (AL), the predominate educational format in higher education is the lecture. The reasons for slow adaptation of AL in medical education are not well understood. The purpose of this survey was to determine knowledge, usage, attitudes, and barriers to AL use in academic Continuing Medical Education (CME). Method A 20-item questionnaire was developed and sent with a link to an online questionnaire to the Society of Academic Continuing Medical Education (SACME) listserv of ~ 350 professionals representing academic medical centers, teaching hospitals, and medical specialty societies in the United States (U.S.) and Canada. Responses were collected with SurveyMonkey® from October–November, 2019. Data were analyzed using SPSS®. Results Responses from 146 SACME members in 91 CME units yielded a ~ 42% survey response rate. Many respondents reported their self-perceived knowledge of AL as high. Advanced training (e.g., certificate, Master of Education degree) was positively correlated with AL knowledge. AL methods were reportedly used in half of the CME activities in the majority (80%) of institutions. Higher levels of self-perceived knowledge were correlated with an increased percentage of AL-related CME activities. Commonly perceived barriers to use of AL were presenters’ lack of familiarity and a need for more time-consuming preparation. Conclusions More efforts are needed to increase innovation and incorporate evidence-based AL strategies in medical education, especially to foster learner engagement, critical thinking, and problem-solving ability.

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