Current state of reflective learning in anaesthesiology residents: a call for 'reflection-on-action' training in Singapore.

Introduction: Reflective learning is the cognitive process whereby information from new experiences is integrated into existing knowledge structures and mental models. In our complex healthcare system, reflective learning (specifically 'reflection on action') is important for postgraduate learners. We observed that our anaesthesiology residents were not building on their competence through deliberate experiential and reflective practice.

Experiential learning improves the learning and retention of endotracheal intubation.

Context: Simulators provide an effective platform for the learning of clinical motor skills such as endotracheal intubation, although the optimal learning technique remains unidentified. We hypothesised that, for novices, experiential learning would improve the learning and retention of endotracheal intubation compared with guided learning.

Methods: Year 4 medical students were randomised to either guided or experiential learning.

Combined spinal-epidural technique for vaginal hysterectomy in a patient with Machado-Joseph disease.

Objective: Machado-Joseph disease is a form of progressive spino-cerebellar ataxia with both bulbar and peripheral neurological manifestations. To date, anesthesia for patients affected by this disease has not been described. General anesthesia may be problematic because of the risk of pulmonary aspiration and hypoxia.

Effective reduction of anxiety and pain during venous cannulation in children: a comparison of analgesic efficacy conferred by nitrous oxide, EMLA and combination.

Background: EMLA cream is the current technique of choice to reduce pain during venous cannulation in most paediatric practice. Its use is limited by logistic arrangements and failure to improve cooperation and allay anxiety. Nitrous oxide (N2O) would appear to be an effective alternative.