Despite the volume of recent publications, there are limited preventive or therapeutic strategies for CIPN supported by high-level evidence. Duloxetine remains the only pharmacologic agent with demonstrated benefit; its clinical use should be routinely considered. Moving forward, nonopioid analgesic therapies will likely play an increasing role in CIPN treatment, but further research is necessary to confirm their utility. Promising therapies include vitamin B12 supplementation, physical therapy, and various forms of neuromodulation.
Objectives: To determine whether information available prior to and during anesthesia residency training can predict American Board of Anesthesiology (ABA) Part 1 (Written) performance and help identify anesthesia residents at risk for failure. Methods: Retrospective analysis of 97 anesthesiology residents' academic files at a single Midwestern residency program. ABA Part 1 score was used as the dependent variable. Categorical demographic predictor variables included gender, under-represented minority status, and type of medical degree. Quantitative academic predictor variables included first-attempt scores on United States Medical Licensing Examination (USMLE) Steps 1 and 2, annual ABA In-Training Exam (ITE) scores, and biannual Basic Science Examination (BSE) scores. Predictors that correlated significantly with the dependent variable were entered into stepwise linear regression analyses. Results:In our analyses, only the USMLE Step 2 score was a significant pre-residency predictor (B=0.169; SE=0.031, p<0.001). Scores on ITEs were significant predictors at every time point. In the final regression model using all available measures during residency, the most recent ITE (B = 0.627; SE=0.090; p<0.001) and BSE (B=0.096; SE = 0.047; p=0.046) scores were significant predictors. The model accounted for 52% of the variance in the outcome variable, with 50% of the variance explained by ITE score alone. The model had a specificity of 0.83 and a sensitivity of 0.82 for predicting passing the ABA Part 1 exam. Conclusions: First-attempt scores on the USMLE Step 2 examination and the CA-2 ITE are moderately strong predictors of anesthesiology board examination performance, and may help target residents who are at risk of failing.
Self-directed learning is associated with knowledge and performance improvements, increased identification and amelioration of knowledge gaps, and heightened critical appraisal of available evidence. We developed and implemented a decision support system that could support self-directed learning for anesthesia residents by soliciting resident input in case selection. We hypothesized that residents would utilize this system to request complex cases, and that more advanced residents would request more complex cases. Prospective, observational study involving 101 anesthesiology residents. We used a web-based interface, RHINOS [Residents Helping in Navigating Operating Room (OR) Scheduling], which allowed residents to share their rank-ordered preferences for OR assignment. Number of cases per OR, anesthesia base units, time units, and proportion of inpatient cases were used as proxies for case complexity. Data were analyzed using a mixed linear model. Residents requested rooms with fewer cases [F(3,22,350) = 194.0; p < 0.001], more base units [F(3,19,158) = 291.4; p < 0.001], more time units [F(3,19,744) = 186.4; p < 0.001], and a greater proportion of cases requiring inpatient preoperative evaluation [F(3,51,929) = 11.3; p < 0.001]. In most cases, these differences were greater for more advanced residents. As hypothesized, residents requested ORs with higher case complexity, and these cases more often required inpatient preoperative evaluation. More advanced residents exhibited a stronger preference for more educational cases than junior residents.
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