STUDY OBJECTIVE:To measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a "good-excellent" level of competence. DESIGN:Prospective study. SETTING:Operating room of a university hospital. SUBJECTS:7 volunteer residents in anesthesiology. MEASUREMENTS:Residents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual's ability was based on the resident's self-assessment score and the attending anesthesiologist's judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). MAIN RESULTS:Each task had a specific learning rate; the number of procedures necessary to achieve "good-excellent" ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. CONCLUSIONS:Awake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides "good-excellent" ability.

译文

目的:测量麻醉学中为清醒开颅手术提供麻醉的居民的学习曲线,并评估达到“卓越”水平所需的病案负荷。
设计:前瞻性研究。
地点:大学医院的手术室。
受试者:7名麻醉学志愿者。
测量:居民接受了清醒开颅手术麻醉临床特征的专门培训计划。该程序分为三个任务:局部麻醉,镇静镇痛和术中血流动力学管理。在10个步骤中记录了每个居民每个任务的学习曲线。对个人能力的定量评估基于居民的自我评估得分和主治麻醉师的判断,并通过改良的12毫米李克特量表,报告的能力得分视觉模拟量表(VAS)进行评估。此功能的VAS分数介于1到12之间(即非常差,中等,中等,足够,良好,非常好)。还记录了咨询请求的数量(即居民要求提供实际帮助和完成程序的理论观念)。
主要结果:每项任务都有特定的学习率。根据记录的结果确定,要有信心达到“优秀”能力所必需的操作数为:局部麻醉10例,镇静镇痛15到25例,术中血流动力学管理20到30例。
结论:清醒颅骨切开术是一种越来越多地用于神经麻醉的方法。基于学习特定任务并建立具有基本特征的自信心的专门培训计划可提供“出色”的能力。

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