Brian Kim Global Health Poster - UCSF Dept of Anesthesia · 2018-05-03 · Case Logs of Anesthesia...
1
Case Logs of Anesthesia Trainees at Makerere University College of Health Sciences in Kampala, Uganda Brian Kim, MD 1 , Michael Lipnick, MD 1 , Gerald Dubowitz, MD 1 , Emmanuel Ayebale, MD 2 , Global Partners in Anesthesia and Surgery Study Group 3 1 Department of Anesthesiology, University of California, San Francisco, CA 2 Department of Anesthesiology, Makerere University, Kampala, Uganda 3 www.globalsurgery.org GLOBAL HEALTH Support in part by grants from the XYZ Background Objectives Results Results (continued) Methods • Only 2 medical centers in Uganda offer training for physicians to be anesthesiologists. • Makerere University College of Health Sciences trains the highest number of physician anesthesiologists. • With improved program development over the past several years, Makerere has graduated up to 8 new trainees per year. • At present, case logs are not being used examined or utilized to distribute cases among trainees. • To analyze the cases that are being performed by new physician trainees at Makerere. • To create a more comprehensive curriculum by setting minimal case requirements for training. • Anesthesia trainees at Makerere University maintain a log of the cases they perform during their training. • Among the pertinent information recorded in the case logs are: • patient age • surgical procedure and specialty • anesthetic technique • urgency of the procedure. • Three 3rd year case logs were analyzed and compared to the program requirements set by the Accreditation Council for Graduate Medical Education (ACGME) in the United States. Acknowledgements • Preliminary analysis taken over an average of 16 months shows that trainees at Makerere already exceed ACGME minimum case requirements for a number of procedures: • Cesarean sections (mean = 69, ACGME min = 20) • Neurosurgical cases (mean = 36, ACGME min = 20) • Pediatric patients < 3 months old (mean = 13, ACGME min = 5). • Spinals (mean = 78, ACGME min = 40) and caudals are common, reflecting the high number of pediatric and obstetric cases. • Epidurals (mean = 9, ACGME min = 40) are performed less frequently due to an inability to adequately monitor patients post-operatively. • The small number of highly specialized surgical sub-specialities performed in Uganda limits the number of cardiothoracic (mean = 16) and major vascular cases being performed by anesthesia trainees. • Interestingly, a small number of cardiac cases are being done under full cardiopulmonary bypass (mean = 5) in a highly specialized, dedicated cardiac theater. Conclusions • Anesthesia trainees at Makerere are exposed to a diverse range of cases. • The volume of pediatric, neurosurgical, obstetric, and general surgery cases is high, while other highly specialized fields are being performed in smaller numbers. • Differences between Ugandan trainee case logs and ACGME standards primarily reflect the limited practice of certain surgical subspecialties in the region. • As additional data is collected, the department of Anesthesiology at Makerere can begin to institute policies to ensure adequate case numbers for trainees based on this regional data and promote a more tailored training curriculum. 20 20 100 Makerere Trainee Case Log Averages vs. ACGME Minimum Standards Number of Cases 0 30 60 90 120 CPB Non-CPB ENT General Gyn Thoracic Maxillo-facial Neuro Cesarean Sxn Other OB Ortho Peds < 3 mo Peds < 3 y/o Peds < 12 y/o Peds Total Plastics Urology Vascular 28 13 86 48 25 13 25 3 69 36 15 2 4 119 18 10 5 20 20 20 5 20 40 Procedure Averages vs. ACGME Minmum Standards Number of Procedures 0 20 40 60 80 Spinal Epidural Peripheral Block 70 9 78 40 40 Variability in Case Numbers Among Third Year Trainees CPB Non-CPB ENT General Gyn Thoracic Maxillo-facial Neuro Cesarean Sxn Other OB Ortho Peds < 3 mo Peds < 3 y/o Peds < 12 y/o Peds Total Plastics Urology Vascular Spinal Epidural Peripheral Block Difference Between Highest and Lowest Case Totals 0 40 80 120 160 68 8 48 36 2 65 41 15 17 41 8 42 30 3 4 9 62 16 7 7 Resident with Lowest Case Numbers Resident with Highest Case Numbers Mulago Trainee Averages ACMGE Minimum Standards Makerere University College of Health Sciences Global Partners in Anesthesia and Surgery
Transcript of Brian Kim Global Health Poster - UCSF Dept of Anesthesia · 2018-05-03 · Case Logs of Anesthesia...
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
Case Logs of Anesthesia Trainees at Makerere University College of Health Sciences in Kampala, Uganda
Brian Kim, MD1, Michael Lipnick, MD 1, Gerald Dubowitz, MD1, Emmanuel Ayebale, MD2, Global Partners in Anesthesia and Surgery Study Group3 1Department of Anesthesiology, University of California, San Francisco, CA 2 Department of Anesthesiology, Makerere University, Kampala, Uganda 3 www.globalsurgery.org
GLOBAL HEALTH
!!!
Support in part by grants from the XYZ
Background
Objectives
Results Results (continued)
Methods
• Only 2 medical centers in Uganda offer training for physicians to be anesthesiologists.
• Makerere University College of Health Sciences trains the highest number of physician anesthesiologists.
• With improved program development over the past several years, Makerere has graduated up to 8 new trainees per year.
• At present, case logs are not being used examined or utilized to distribute cases among trainees.
• To analyze the cases that are being performed by new physician trainees at Makerere.
• To create a more comprehensive curriculum by setting minimal case requirements for training.
• Anesthesia trainees at Makerere University maintain a log of the cases they perform during their training.
• Among the pertinent information recorded in the case logs are: • patient age • surgical procedure and specialty • anesthetic technique • urgency of the procedure.
• Three 3rd year case logs were analyzed and compared to the program requirements set by the Accreditation Council for Graduate Medical Education (ACGME) in the United States.
Acknowledgements
• Preliminary analysis taken over an average of 16 months shows that trainees at Makerere already exceed ACGME minimum case requirements for a number of procedures: • Cesarean sections (mean = 69, ACGME min = 20) • Neurosurgical cases (mean = 36, ACGME min = 20) • Pediatric patients < 3 months old (mean = 13, ACGME min = 5).
• Spinals (mean = 78, ACGME min = 40) and caudals are common, reflecting the high number of pediatric and obstetric cases.
• Epidurals (mean = 9, ACGME min = 40) are performed less frequently due to an inability to adequately monitor patients post-operatively.
• The small number of highly specialized surgical sub-specialities performed in Uganda limits the number of cardiothoracic (mean = 16) and major vascular cases being performed by anesthesia trainees.
• Interestingly, a small number of cardiac cases are being done under full cardiopulmonary bypass (mean = 5) in a highly specialized, dedicated cardiac theater.
Conclusions• Anesthesia trainees at Makerere are exposed to a diverse range of cases. • The volume of pediatric, neurosurgical, obstetric, and general surgery cases is high,
while other highly specialized fields are being performed in smaller numbers. • Differences between Ugandan trainee case logs and ACGME standards primarily
reflect the limited practice of certain surgical subspecialties in the region. • As additional data is collected, the department of Anesthesiology at Makerere can
begin to institute policies to ensure adequate case numbers for trainees based on this regional data and promote a more tailored training curriculum.
20 20
100!
Makerere Trainee Case Log Averages vs. ACGME Minimum Standards
Num
ber o
f Cas
es
0
30
60
90
120
CPB
Non-CPB
ENT
General
Gyn
ThoracicMaxillo-facialNeuroCesarean SxnOther OB
Ortho
Peds < 3 moPeds < 3 y/oPeds < 12 y/oPeds TotalPlastics
Urology
Vascular
0
28
13
86
48
25
13
25
3
69
36
15
24
119
18
105
20 20 20
5
20
40
Procedure Averages vs. ACGME Minmum
Standards
Num
ber o
f Pro
cedu
res
0
20
40
60
80
SpinalEpiduralPeripheral Block
70
9
78
40 40
Variability in Case Numbers Among Third Year Trainees
CPB
Non-CPB
ENT
General
Gyn
Thoracic
Maxillo-facial
Neuro
Cesarean Sxn
Other OB
Ortho
Peds < 3 mo
Peds < 3 y/o
Peds < 12 y/o
Peds Total
Plastics
Urology
Vascular
Spinal
Epidural
Peripheral Block
Difference Between Highest and Lowest Case Totals0 40 80 120 160
68
8
48
36
2
65
41
15
17
41
8
42
30
3
4
9
62
16
7
7
Resident with Lowest Case NumbersResident with Highest Case Numbers
Mulago Trainee Averages ACMGE Minimum Standards
Makerere University College of Health Sciences
Global Partners in Anesthesia and Surgery
