A Double Edged Sword: How Technology is Shaping Anesthesiology Residency
A Double Edged Sword: How Technology is Shaping Anesthesiology Residency
Anesthesiology has evolved significantly since the days of chloroform induction and the copper kettle. Technological advancements have given us the ability to gather real time intraoperative data to provide personalized, safe and effective medical care. The emergence of the electronic medical record (EMR), paging systems, and ultrasound particularly affect anesthesiology trainees given frequent use of these technologies to provide anesthetic care and I want to spend some time reflecting on the implications for the modern trainee. While beneficial in many regards, the hardware and software technology we rely upon to provide anesthesia daily is not without fault, and has subtle negative consequences that are often overlooked or hard to appreciate.
The EMR and web based, two-way paging systems have exponentially improved medical care. A modern EMR allows for seamless, concise, and efficient record keeping. It also facilitates sharing of information about patient care across specialties and disciplines. Also, providers can easily evaluate prior anesthetics and anticipate potential complications in upcoming surgeries without needing to visit medical records to pull paper charts. Paging systems accelerate communication between trainees and members of the care team such as attending physicians, nurses, and pharmacists. Attending physicians are more rapidly notified of intraoperative events due to the use of EMR and paging systems as well.
Software technologies such as EMR and paging systems are also prone to downtime and do not always work as intended. With modern cybersecurity threats, they may have more extended downtime as Lurie Children’s Hospital in Chicago is now experiencing1. With frequent upgrades, many EMR systems require retraining as the software is continually being revised. In an effort to improve user experience, workflows can change (drastically at times). This is particularly impactful on the residency experience given how much of a resident’s time is spent documenting. Paging systems have also made resident physicians more accessible. While advantageous in many situations, it also has the unintended consequence of allowing trainees to be contacted when outside the hospital. This can leave trainees unable to fully “unplug” when away from their institution and can contribute to burnout within residency. It is true a resident can sign off or mark themselves as off duty, but this is more challenging than simply turning a physical pager off.
The development of ultrasound has revolutionized anesthesiology. It provides the ability to visualize patient anatomy at the bedside, spontaneously, and noninvasively. It has allowed physicians to perform more delicate and technical procedures, and lowers likelihood of complications2. Many residents believe, and studies have corroborated, that procedures are quicker and cause less harm when done with ultrasound. Many of my colleagues place arterial lines primarily with real time ultrasound guidance. My decision to use ultrasound in the OR is multifactorial and dependent on if the attending physician I am with is comfortable with me “practicing” without the use of ultrasound, how eager the surgical team is to begin operating as it is easy for anesthesiology trainees to feel rushed by their surgical colleagues, and dependent on patient factors (do I feel a strong pulse, do they have significant vascular disease, have they had neuropathy from a prior arterial line or surgery).
With the quick pace of technological growth, this also means trainees must also regularly learn how to use new technology in order to remain competitive with their skills and knowledge. This requires protected time to learn about that technology. Considering the use of ultrasound has become standard for peripheral nerve blocks, and is routinely used for central and arterial access, landmark-based techniques have become de-emphasized in medical education. Unsurprisingly, residents become reliant on ultrasound technology and are uncomfortable performing these procedures without the use of ultrasound. This becomes detrimental during emergent cases when patients are in critical condition or during situations where machinery fails, malfunctions, or is limited in availability. It is of paramount importance that trainees learn ways to circumvent these challenges and function without the use of physical technology to provide the best patient care.
In conclusion, the benefits of technology are proven and evident; streamlined communication, effective documentation, more precise equipment, and safer procedures all in patients that are getting sicker as we push the limits on surgical viability. However, it is important we not forget the unintended and sometimes covert negative impacts technology has on graduate medical education. I believe it is important for residency programs to understand how residents interact with technology on a day-to-day basis because it shapes the resident experience and ultimately affects the caliber of resident trained. Regarding use of paging systems, despite being “offline” or “off duty” it is not uncommon to receive pages/messages. While majority are not critical, it is hard not to respond knowing that a lack of response may cause a delay in patient care. There are very few residents who would choose to go back to the days without a text based two-way paging system, but the bombardment of information due to cell phones does impact residents, especially given that it is another person's medical care at stake. Lastly, hardware and software technologies are prone to malfunctioning and cyberattack. For residency to be holistic, training on how to navigate situations involving complications, failures, EHR “downtime”, and lack of access to this equipment is essential and must be included. I believe it is very important that residents are challenged and given the time to develop these skills during non-critical cases so that during trauma situations we have more than one skill to rely upon. This will require support and patience from our faculty as we attempt to do things differently. Ultimately, if the goal of a residency program is to train compassionate and competent anesthesiologists, I believe awareness of these covert effects of technology is quite important as it can help faculty better understand what residency training in 2024 is truly like.
- Cyberattacks on hospitals are likely to increase, putting lives at risk, experts warn. AP Article. Accessed Online 2/22/2024. https://apnews.com/article/cyberattacks-hospital-lurie-childrens-ransom-eb6f9528198b4e3c2a5e82f74c4cb7e9?utm_source=copy&utm_medium=share
- Ultrasound-Guided Artery Cannulation Technique Versus Palpation Technique in Adult Patients in Pre-Anesthesia Room: A Randomized Controlled Trial
Yu Y, Lu X, Fang W, LiuX , Lu Y. Med Sci Monit. 2019; 25: 7306–7311. PMID: 31563919
About the Author
Katie Christianson is a CA1 resident at Loyola University Medical Center in Maywood, IL.
