Guidelines about the use of neuromuscular blocking agents based on a national consensus conference have been published in 2000. A survey was carried out to assess adherence to these guidelines. An online questionnaire was designed from the different guidelines concerning the use of muscle relaxant for tracheal intubation and surgery, monitoring and antagonism of neuromuscular blockade. In addition, question about the knowledge of the pharmacodynamics of neuromuscular blocking agents were asked. Analysis concerned 1230 answers from senior anaesthetists. Tracheal intubation is facilitated by the use of a competitive agent or by succinylcholine by 58 and 8% of responders respectively. Atracurium and cisatracurium were most frequently used (49 and 44%, respectively). The duration of effect of an intubating dose of atracurium, vecuronium or rocuronium was estimated equal or below 60 min by more than half of responders, whereas that of cisatracurium was longer. Fifty-two or 74% of responders used neuromuscular monitoring, whether a single or repeated dose of muscle relaxant was administered. Antagonism of neuromuscular blockade was systematic, frequent, and episodic or excluded by 6, 26, 55 and 13% of responders, respectively. Monitoring and antagonism of neuromuscular blockade are underused despite the guidelines. Underestimation of the risk of postoperative residual curarization is linked to the underestimation of the duration of competitive neuromuscular blocking agents.

Enquête de pratique sur l'utilisation en France des curares chez l'adulte en anesthésie

Introduction With the COVID-19 pandemic, most continuing medical education activities became virtual (VCME). The authors conducted a scoping review to synthesize the advantages and disadvantages of VCME to establish the impact of this approach on inequities that physicians face along the intersections of gender, race, and location of practice. Methods Guided by the methodological framework of Arksey and O’Malley, the search included six databases and was limited to studies published between January 1991 to April 2021. Eligible studies included those related to accredited/non-accredited post-certification medical education, conferences, or meetings in a virtual setting focused on physicians. Numeric and inductive thematic analyses were performed. Results 282 studies were included in the review. Salient advantages identified were convenience, favourable learning formats, collaboration opportunities, effectiveness at improving knowledge and clinical practices, and cost-effectiveness. Prominent disadvantages included technological barriers, poor design, cost, lack of sufficient technological skill, and time. Analysis of the studies showed that VCME was most common in the general/family practice specialty, in suburban settings, and held by countries in the Global North. A minority of studies reported on gender (35%) and race (4%). Discussion Most studies report advantages of VCME, but disadvantages and barriers exist that are contextual to the location of practice and medical subspecialty. VCME events are largely organized by Global North countries with suboptimized accessibility for Global South attendees. A lack of reported data on gender and race reveals a limited understanding of how VCME affects vulnerable populations, prompting potential future considerations as it evolves.

/pdf/on-the-advantages-and-disadvantages-of-virtual-continuing-34tkbkav.pdf

On the advantages and disadvantages of virtual continuing medical education: a scoping review

Iconographies supplémentaires de l'article : Enquête de pratique sur l’utilisation en France des curares chez l’adulte en anesthésie

Summary Background and aims Residents must balance patient care and the ongoing acquisition of medical knowledge. With increasing clinical responsibilities and patient overload, medical training is often left aside. In 2010, we designed and implemented a training course in neonatology and pediatric emergency medicine for residents in pediatrics, in order to improve their medical education. The course was made of didactic sessions and several simulation-based seminars for each year of residency. We conducted this study to assess the impact of our program on residents’ satisfaction and self-assessed clinical skills. Methods A survey was conducted at the end of each seminar. The students were asked to complete a form on a five-point rating scale to evaluate the courses and their impact on their satisfaction and self-assessed clinical skills, following the French National Health Institute's adapted Kirkpatrick model. Results Sixty-four (84%) of the 76 residents who attended the courses completed the form. The mean satisfaction score for the entire course was 4.78 ± 0.42. Over 80% of the students felt that their clinical skills had improved. Conclusion Medical education is an important part of residency training. Our training course responded to the perceived needs of the students with consistently satisfactory evaluations. Before the evaluation of the impact of the course on patient care, further studies are needed to assess the acquisition of knowledge and skills through objective evaluations.

Implementation and assessment of a training course for residents in neonatology and pediatric emergency medicine.

Resume Objectif Determiner le type et le niveau de la formation initiale en anesthesie locoregionale (ALR) des internes du diplome d’etudes specialisees en anesthesie-reanimation (DESAR), et particulierement des internes de cinquieme annee de DESAR, ainsi que son adequation aux recommandations du comite douleur-ALR de la Societe francaise d’anesthesie et de reanimation (Sfar). Type d’etude Enquete declarative de pratiques. Materiel et methodes Un questionnaire a choix multiples a ete envoye en septembre 2007 a l’ensemble des internes inscrits au DESAR en France. Les questions interessaient des donnees demographiques (annee de DESAR, CHU de rattachement, formation theorique, type et duree des stages d’ALR) et des donnees sur la pratique de l’ALR, concernant principalement les blocs « indispensables » a connaitre en fin de cursus par les internes, le niveau de pratique et l’autonomie acquise au cours du cursus, notamment en cinquieme et troisieme annees (DESAR5 et DESAR3). Apres envoi du questionnaire, deux relances etaient effectuees, les reponses parvenant par voie electronique ou postale. Resultats Le taux global de reponse est de 29,1 % (25,3 % et 23,4 % pour les DESAR5 et les DESAR3 respectivement). Vingt-neuf pour cent de l’ensemble des DESAR avaient recu des cours d’anatomie, 33 % pratiquaient la dissection et 38 % suivaient des formations complementaires. Pour les DESAR5, l’objectif minimum de 30 actes effectues etait atteint a 98 % pour l’anesthesie peridurale (APD), 95 % pour la rachianesthesie (RA), 82 % pour les blocs axillaire et humeral et 72 % pour le bloc femoral, avec une autonomie declaree de 100 %. Conclusion Les objectifs fixes par les recommandations francaises ne sont que partiellement atteints. Cet echec apparent peut etre du a un manque d’exposition, a un encadrement inadequat et aux habitudes pratiques en stage, ainsi qu’a l’evolution de certaines pratiques medicales.

Enquête sur la formation initiale des internes français en anesthésie locorégionale

Resume Type d'etude. – Le but de cette etude etait d'evaluer les caracteristiques de la formation medicale continue (FMC) des anesthesistes–reanimateurs francais (AR). Methodes. – Un questionnaire de 73 items a ete adresse par courrier a un echantillon de 1000 AR dont la repartition par region, par sexe et par type d'etablissement refletait la repartition nationale. Un second envoi a ete realise six semaines apres en cas de non-reponse. Resultats. – Le taux de reponses a ete de 40,8 %. Les repondants sont similaires a la population des AR francais, en termes d'activite, d'âge, de type d'exercice professionnel. L'adhesion aux societes savantes francaises d'anesthesie reanimation s'eleve a 72 % auxquels s'ajoutent 24 % d'affiliations a des societes d'autres disciplines. La frequentation de congres francophones s'eleve a 81 % qui sont apprecies de facon similaire ; mais seulement 17 % des AR assistent a des congres internationaux. Les congres generalistes sont preferes par 67 % des AR. Annuellement, on recense une mediane de six jours en congres plus quatre jours de stage ; 89 % des AR lisent des revues medicales (37 % etrangeres). La formation est partiellement prise en charge financierement dans 61 % des cas. Internet est utilise en FMC par 73 % des AR sur des sites francophones. Les facteurs temps et financier sont les deux principales limites invoquees pour la FMC. Conclusion. – La FMC est un phenomene etabli en France au vu de nos resultats. L'ouverture vers les interfaces internationales reste cependant modeste.

Enquête nationale sur la formation médicale continue des anesthésistes–réanimateurs

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Enquête nationale sur la formation médicale continue des anesthésistes–réanimateurs