April 2000
Volume 64 |
Number 4
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| A Survey of Residency
Programs' Didactics |
Fran Thayer, M.D.
Alternate Resident Delegate to California Society of Anesthesiologists
At the ASA Resident Component Annual Meeting in Dallas, Texas,
last October, we covered many issues. One topic that resurfaced
was concern with didactics in our programs. Residents wonder if
their programs are really educating them well. To examine the
debate, I decided to do a survey comparing features of didactics
in anesthesiology residency programs.
Curiosity led me to question how residents pursued learning.
Did they use any special study aids? What books did they read
and how many hours did they spend reading? How many hours did
they think they should be reading? I determined preferences in
learning by including questions on methods residents felt worked
best.
The survey was e-mailed to 500 residents, and results tallied
were not subject to any sort of rigorous scientific method. I
received only 19 answered questionnaires from 15 different programs
ranging in size from seven to 100 residents. I had four CA-1 respondents,
eight CA-2 respondents, six CA-3 respondents and one fellow. Despite
the low response rate to the e-mails, many interesting points
emerged that are worthy of discussion.
All respondents had a general lecture series. The frequency
ranged from one to four times per week. Despite differences in
frequency, all programs averaged two hours of lecture time per
week. Content was offered both topically and through case presentation,
and was taught by both roundtable discussion and straight presentation.
There were usually handouts and some form of audiovisual presentation.
Program chairs were sometimes in attendance. Half of the respondents
were able to attend at least 75 percent of the time. Most respondents
felt the general lecture series was valuable.
Eighty percent of the programs had morbidity and mortality rounds,
where residents and faculty were responsible for the presentation.
Handouts were less likely, but audiovisual support was usually
present, as were program chairs. Three-quarters of the respondents
attended at least 75 percent of the time. Over 50 percent of the
respondents reported being relieved of their operating room duties
to attend. Most felt these rounds to be valuable or extremely
valuable.
Two-thirds of the respondents' programs had grand rounds, generally
consisting of a formal presentation by either faculty or visiting
faculty. There were usually handouts, and audiovisual presentation
was used most of the time. The chair was usually present. All
respondents with grand rounds reported being able to attend at
least 75 percent of the time and most were relieved to attend.
All felt these rounds to be valuable or extremely valuable.
Only one-quarter of the programs had keyword sessions. They
were usually taught by residents or staff. The program chair did
not attend, but more significantly, half found them of no value
at all!
Eighty-seven percent of respondents' programs had special sessions
for board preparations. Most were mock orals given once or twice
yearly. About one-quarter of the respondents had written practice
exams. All felt that board preparation sessions were valuable
or extremely valuable.
Many of the respondents (83 percent) had journal club. Frequency
varied from weekly to four times per year with once a month the
average. The program chair sometimes attended. Residents, however,
only attended one-half of the time, perhaps due to one-quarter
reporting that it was not valuable.
About two-thirds of the respondents attended an educational
meeting. Educators should take note that three-quarters of those
who attended felt this experience to be extremely valuable, and
60 percent had monetary help from their programs!
Only half of the respondents' programs used simulators. Many
felt that simulators were a valuable or extremely valuable experience.
(To read more about simulators, see article on page 9 by Stanislav
S. Malov, M.D.)
The book most read by residents was Clinical Anesthesiology,
by G. Edward Morgan, Jr., M.D., and Maged S. Mikhail, M.D. This
was followed by Basics of Anesthesia, by Robert K. Stoelting,
M.D., and Ronald D. Miller, M.D., and then Clinical Anesthesia,
by Paul G. Barash, M.D. Most respondents read two to four hours
per week but desired to read five to 10 hours. Three-quarters
of the respondents skimmed journals, with Anesthesiology
most often cited. Other journals mentioned included Anesthesia
& Analgesia and Regional Anesthesia and Pain Medicine.
While most respondents use the Internet as a study resource,
this figure is biased since the questionnaire was given via Internet
(e-mail) only. The Internet was used less than 25 percent of the
time, however. The two sites mentioned most were GASNet™
and The Answer Page.
One-quarter of the respondents were undecided about attending
a formal board exam training program, and half were not considering
attendance at this time.
Respondents were split on preferring roundtable versus straight
presentation lectures. Respondents overwhelmingly preferred asking
specific questions and receiving answers as their most valuable
assimilation tool.
The next most valuable method was preparing a topic to present
-- a lot of work for a rather focused amount of knowledge gained.
This tool was followed closely by formal presentations with a
handout. The most unfavorable method cited was being put on the
spot and possibly not knowing the answer. The stress factor was
not valued as being conducive to learning.
Respondents were asked to rank eight learning tools in order
of importance. Some respondents were only able to rank four or
five tools since their programs did not offer all of the features.
These results, with the most popular listed first, include: 1)
operating room teaching, 2) general lecture series, 3) morbidity
and mortality, 4) grand rounds, 5) simulators, 6) journal club,
7) keywords and 8) in-training exam sessions.
The survey included a question asking how often teaching was
received in the operating room. One-third reported less than 25
percent of the time, while only one-quarter of the respondents
received teaching 50 to 75 percent of the time. Respondents were
also asked to offer suggestions to anesthesia faculty educators,
and most centered on the need for more teaching, especially in
the operating room.
Lastly, respondents were asked to offer recommendations to fellow
residents. One respondent suggested that residents should "work
hard" during their training. The programs examined seemed to have
many of the same features, especially those that were deemed valuable
by the respondents, i.e., general lecture series, morbidity and
mortality and ground rounds. All respondents' programs seemed
to be suffering a similar problem: a lack of teaching in the operating
room. If your program does not have simulators or in-training
exam sessions (two features felt to be valuable by respondents),
you may want to ask for them.
One respondent suggested that residents should come together
once a month to discuss issues concerning their education. We
were able to do that at the ASA Annual Meeting in Dallas, Texas.
Because of our meetings, many concerns and proposals have been
put into action. One resolution brought before the 1999 Resident
House of Delegates was the recommendation that programs use simulators.
Clearly, we need to have residents directly involved in their
education, politics and future careers. Change is up to us. I
challenge you to see what you can do at your own programs!
I wish to thank all the respondents for taking the time
to answer this survey. For a copy of this survey, you may write
Dr. Thayer at 416 28th Street, Manhattan Beach, CA 90266 or by
e-mail.
The survey included a question asking how often teaching was
received in the operating room. One-third reported less than 25
percent of the time, while only one-quarter of the respondents received
teaching 50 to 75 percent of the time.
Fran Thayer, M.D., is a CA-2 resident in
anesthesiology at the University of Southern California, Los Angeles,
California.
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