Caldwell Matthew D, Naughton Norah N, Kumar Sathish S, Mathis Michael R, Colquhoun Douglas, Mentz Graciela B, Yuan Yuan, Zisblatt Lara
From the Department of Anesthesiology.
Department of Computational Bioinformatics, University of Michigan Medicine, Ann Arbor, Michigan.
Anesth Analg. 2025 Mar 27. doi: 10.1213/ANE.0000000000007477.
Clinical experience is foundational to graduate medical education but is difficult to quantify. Self-reported case logs and scheduled rotations provide limited detail on residents' actual experiences. The analysis of electronic health record (EHR) data may provide a more comprehensive view of residents' actual clinical experiences. We aimed to quantify and characterize residents' direct clinical experiences with intraoperative transfusion management as a proof of concept for the utility of EHR data in anesthesiology graduate medical education.
This retrospective observational study aimed to measure the participation of anesthesiology residency graduates with intraoperative transfusion management at a single institution. Data pertaining to the University of Michigan cases submitted to the Multicenter Perioperative Outcomes Group (MPOG) data registry from January 1, 2012, to December 31, 2022, were analyzed. The primary outcome was participation in intraoperative transfusion management defined by the transfusion of any volume of homologous packed red blood cells (pRBC) documented within the intraoperative anesthesia record. Subgroup analysis characterized resident participation in severe intraoperative hemorrhage resuscitation defined as the transfusion of ≥4 pRBCs. Additional outcomes were participation in non-pRBC blood product transfusion and transfusion of cell-salvaged blood. Surgical case and resident-specific factors were analyzed for association with resident participation in intraoperative pRBC transfusion.
Throughout the study period, 231 residents from 8 graduating cohorts were involved in 222,006 anesthetic cases of which 8529 (4%) included intraoperative pRBC transfusion. Over the entire course of residency training, residents on average participated in 37 (standard deviation [SD] = 8) cases with intraoperative pRBC transfusion with a range of 16 to 60. The mean (SD [range]) participation with severe hemorrhage resuscitation was 10 (3 [2-22]), participation with non-pRBC transfusion was 7 (3 [1-14]), and participation with cell salvaged blood was 13 (4 [3-26]). Five of 19 surgical services (cardiac, transplant, vascular, neurosurgery, orthopedic) accounted for the majority (5668; 66%) of intraoperative transfusion management experiences.
Variation exists in the transfusion management experience among trainees at a single academic center. This study supports the feasibility of using EHR data to quantify the clinical experiences of residents beyond the assumptions underlying self-reported case logs and time on specialty rotations. Such analyses may allow for interventions to optimize the frequency, timing, and sequencing of clinical care activities to ensure optimal clinical experience.
临床经验是毕业后医学教育的基础，但难以量化。自我报告的病例日志和预定的轮转提供了关于住院医师实际经历的有限细节。电子健康记录（EHR）数据分析可能会提供住院医师实际临床经验的更全面视图。我们旨在量化和描述住院医师在术中输血管理方面的直接临床经验，以此作为EHR数据在麻醉学毕业后医学教育中效用的概念验证。
这项回顾性观察性研究旨在衡量单一机构中麻醉学住院医师毕业生参与术中输血管理的情况。分析了2012年1月1日至2022年12月31日提交给多中心围手术期结果组（MPOG）数据登记处的密歇根大学病例数据。主要结局是参与术中输血管理，定义为术中麻醉记录中记录的任何量的同源浓缩红细胞（pRBC）输血。亚组分析描述了住院医师参与严重术中出血复苏的情况，定义为输注≥4个pRBC。其他结局是参与非pRBC血液制品输血和回收式自体输血。分析手术病例和住院医师特定因素与住院医师参与术中pRBC输血的相关性。
在整个研究期间，来自8个毕业队列的231名住院医师参与了222,006例麻醉病例，其中8529例（4%）包括术中pRBC输血。在住院医师培训的整个过程中，住院医师平均参与了37例（标准差[SD]=8）术中pRBC输血病例，范围为16至60例。严重出血复苏的平均（SD[范围]）参与次数为10次（3次[2 - 22次]），非pRBC输血的参与次数为7次（3次[1 - 14次]），回收式自体输血的参与次数为13次（4次[3 - 26次]）。19个外科科室中的5个（心脏、移植、血管、神经外科、骨科）占术中输血管理经验的大部分（5668例；66%）。
单一学术中心的受训人员在输血管理经验方面存在差异。本研究支持使用EHR数据来量化住院医师的临床经验，而不仅仅基于自我报告的病例日志和专科轮转时间的假设。此类分析可能允许进行干预，以优化临床护理活动的频率、时机和顺序，以确保获得最佳临床经验。
