Training anesthesiology residents in providing anestesia for awake craniotomy: Learning curves and estimate of needed case load

Study Objective: To measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a “good-excellent” level of competence. Design: Prospective study. Setting: Operating room of a university hospital. Subjects: 7 volunteer residents in anesthesiology. Measurements: Residents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual’s ability was based on the resident’s selfassessment score and the attending anesthesiologist’s judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). Main Results: Each task had a specific learning rate; the number of procedures necessary to achieve “goodexcellent” ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. Conclusions: Awake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides “goodexcellent” ability.