title: Lack of Association between Blood Pressure Management by Anesthesia Residents and Competence Committee Evaluations or In-training Exam Performance: A Cohort Analysis.
abstract: BACKGROUND
  Prompt treatment of severe blood pressure instability requires both cognitive and technical skill. The ability to anticipate and respond to episodes of hemodynamic instability should improve with training. The authors tested the hypothesis that the duration of severe hypotension during anesthesia administered by residents correlates with concurrent adjusted overall performance evaluations by the Clinical Competence Committee and subsequent in-training exam scores.
  
  
  METHODS
  The authors obtained data on 70 first- and second-year anesthesia residents at the Cleveland Clinic. Analysis was restricted to adults having noncardiac surgery with general anesthesia. Outcome variables were in-training exam scores and subjective evaluations of resident performance ranked in quintiles. The primary predictor was cumulative systolic arterial pressure less than 70 mmHg. Secondary predictors were administration of vasopressors, frequency of hypotension, average duration of hypotensive episodes, and blood pressure variability.
  
  
  RESULTS
  The primary statistical approach was mixed-effects modeling, adjusted for potential confounders. The authors considered 15,216 anesthesia care episodes. A total of 1,807 hypotensive episodes were observed, lasting an average of 32 ± 20 min (SD) per 100 h of anesthesia, with 68% being followed by vasopressor administration. The duration of severe hypotension (systolic pressure less than 70 mmHg) was associated with neither Competence Committee evaluations nor in-training exam scores. There was also no association between secondary blood pressure predictors and either Competence Committee evaluations or in-training exam results.
  
  
  CONCLUSIONS
  There was no association between any of the five blood pressure management characteristics and either in-training exam scores or clinical competence evaluations. However, it remains possible that the measures of physiologic control, as assessed from electronic anesthesia records, evaluate useful but different aspects of anesthesiologist performance.
authors.affiliation: From the Departments of Outcomes Research (D.I.S., N.M.), Department of Quantitative Health Sciences (N.M.), Department of Pediatric Anesthesia (R.R.-P., S.K.), and Anesthesiology Institute (D.L.B.), Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Natalya
authors.initials: N
authors.lastname: Makarova
authors.forename: Ricardo
authors.initials: R
authors.lastname: Riveros-Perez
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.forename: Stephen
authors.initials: S
authors.lastname: Kimatian
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000776:Anesthesiology / Q000193:education*; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015331:Cohort Studies; D019468:Disease Management; D004521:Educational Measurement / Q000706:statistics & numerical data*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology; D007396:Internship and Residency / Q000706:statistics & numerical data*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents