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LETTER TO THE EDITOR

Teaching and Operating Room Efficiency

Department of Anesthesiology; Yale University School of Medicine and Yale-New Haven Hospital; New Haven, CT; paul.barash{at}yale.edu

In Response:

We appreciate the kind comments of Dr. Pivalizza et al. For these studies, the primary anesthesiology provider of the anesthesia care team was recorded in data collection (1,2). Since medical students and others are "inserted" into the anesthesia care team during their rotation, we did not stratify the data by medical student, paramedical staff, etc. As we reported in the Discussion, teaching can occur in other parts of the perioperative period, such as maintenance of anesthesia or postanesthetic debriefing, for example. In the current economic climate, this study strongly suggests that other educational paradigms for resident teaching may be required. These include more extensive use of computerized instruction and simulators. Alternatively, faculty can prioritize resident instruction for a given case, such that the necessary aspects of important principles of induction are emphasized ("the teachable moment") during the induction phase and other aspects of patient care are developed at other time points during the perioperative period.

REFERENCES

1. Davis EA, Escobar A, Ehrenworth J, et al. Resident teaching versus the operating room schedule: An independent observer- based study of 1558 cases. Anesth Analg 2006;103:932–7.[Abstract/Free Full Text]
2. Escobar A, Davis EA, Ehrenworth J, et al. Task analysis of the preincision surgical period: An independent observer-based study of 1558 cases. Anesth Analg 2006; 103:922–7.[Abstract/Free Full Text]

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