Simulator Limitations and Their Effects on Decision-Making (original) (raw)
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Inefficacy of simulator-based training on anaesthesiologists' non-technical skills
Acta Anaesthesiologica Scandinavica, 2009
Background: Analysis of critical incidents in anaesthesia practice emphasizes the important role of non-technical skills (NTS) in improving patient safety. Therefore, debriefing with regard to NTS has been added to medical management (MM) simulator training to improve acute crisis competencies of anaesthesiologists. The purpose of this study was to compare the NTS and MM performance of two groups of anaesthesiologists in a simulated anaesthesia crisis after undergoing different types of training. Methods: Forty-two anaesthesiologists were randomly assigned to two different training groups, with each group participating in two simulation training sessions. One group's (NTS1MMG) training included extensive debriefing of NTS (resource management, planning, leadership and communication) and MM, while the other group (MMG) received a simpler debriefing that focused solely on MM. The quality and quantity of NTS and quality of MM performance were rated by reviewing the videotapes of the scenarios. Results: NTS1MMG did not prove superior to MMG with regard to behavioural and MM markers. The quality of NTS performances correlated significantly (Po0.01) with the quantity of NTS demonstration, and also correlated significantly with the MM actions (Po0.01) in both groups. Conclusion: A single session of training including debriefing of NTS and MM did not improve the NTS performances of anaesthesiologists when compared with anaesthesiologists who only received MM training. This might indicate that a more frequent or individual training is needed to improve participants' NTS performance.
Anesthesia & Analgesia, 2002
In this study, we compared two different training simulators (the computer screen-based simulator versus the fullscale simulator) with respect to training effectiveness in anesthesia residents. Participants were evaluated in the management of a simulated preprogrammed scenario of anaphylactic shock using two variables: treatment score and diagnosis time. Our results showed that simulators can contribute significantly to the improvement of performance but that learning in treating simulated crisis situations such as anaphylactic shock did not significantly vary between full-scale and computer screen-based simulators. Consequently, the initial decision on whether to use a full-scale or computer screen-based training simulator should be made on the basis of cost and learning objectives rather than on the basis of technical or fidelity criteria. Our results support the contention that screen-based simulators are good devices to acquire technical skills of crisis management. Mannequin-based simulators would probably provide better training for behavioral aspects of crisis management, such as communication, leadership, and interpersonal conflicts, but this was not tested in the current study. (Anesth Analg 2002;94:1560 -5) T he use of full-scale (FS) simulators for training in anesthesia is becoming a topic of great interest and a source of controversy in the anesthesia profession. One reason is their purchase and maintenance costs. Another is their effectiveness compared with other less-expensive training methods. Yet, Chopra et al.
Evaluation of high fidelity patient simulator in assessment of performance of anaesthetists
British Journal of Anaesthesia, 2003
Background. There is increasing emphasis on performance-based assessment of clinical competence. The High Fidelity Patient Simulator (HPS) may be useful for assessment of clinical practice in anaesthesia, but needs formal evaluation of validity, reliability, feasibility and effect on learning. We set out to assess the reliability of a global rating scale for scoring simulator performance in crisis management. Methods. Using a global rating scale, three judges independently rated videotapes of anaesthetists in simulated crises in the operating theatre. Five anaesthetists then independently rated subsets of these videotapes. Results. There was good agreement between raters for medical management, behavioural attributes and overall performance. Agreement was high for both the initial judges and the ®ve additional raters. Conclusions. Using a global scale to assess simulator performance, we found good inter-rater reliability for scoring performance in a crisis. We estimate that two judges should provide a reliable assessment. High ®delity simulation should be studied further for assessing clinical performance.
Anesthesiology, 2005
Background: Critical incident reporting and observational studies have identified nontechnical skills that are vital to successful anesthesia crisis management. Examples of such skills include task management, team working, situation awareness, and decision making. These skills are not necessarily acquired through clinical experience and may need to be specifically taught. This study uses a high-fidelity patient simulator to assess the effect of repeated exposure to simulated anesthesia crises on the nontechnical skills of anesthesia residents.
Chapter 45 . Simulator-Based Training and Patient Safety
2001
For a number of years, simulators have been used in aviation, nuclear power, military flight operations and other industries as a training tool and method to assess performance. Their use is nearly universal in high reliability organizations. Recently the use of simulation in medicine has increased markedly, in part due to greater awareness of the importance of patient safety. Defined broadly, a simulator replicates a task environment with sufficient realism to serve a desired purpose. In medical training, simulators can substitute for actual patients and can be as simple as utilizing pigs’ feet to practice suturing, or as complex as virtual reality machines and re-creations of actual clinical environments for surgeons, radiologists and anesthesiologists. In a general sense, they improve patient safety by allowing physicians to become better trained without putting patients at risk. For example, in a randomized controlled trial, Peugnet and colleagues used a virtual reality simulato...
Journal of Veterinary Medical Education, 2018
A veterinary anesthesia simulated environment (VASE) with clinical scenarios has been integrated into the pre-clinical curriculum at Midwestern University College of Veterinary Medicine to simulate anesthesia of a live patient within a surgical suite. Although this modality was shown to significantly improve veterinary students' perceived preparedness to perform anesthesia on live patients, whether this would improve anesthesia competency in the actual clinical environment, described as operational performance, remained unclear. Our goal was to examine the relationship between anesthesia simulation training and student anesthesia operational performance. Anesthesia operational performance assessment of students was determined by quantifying critical event occurrences that negatively impacted patient safety during the anesthesia of 287 patients during students' initial surgical experience in 2015 and 2016. The relationship between total numbers of critical incidents to students having anesthesia simulation training was determined through evaluation of anesthesia records from 2015 and 2016, where students did not have anesthesia simulation training or they had pre-clinical training, respectively. Results showed a significant relationship between simulation training and critical incident occurrence, with a critical incident more likely to occur during patient anesthesia for students who did not experience pre-clinical anesthesia simulation training. Of the total critical incidents that occurred in the two-year study, 88% were in patients anesthetized by students who did not have simulation training. Our findings suggest that students who were given the opportunity to participate in anesthesia-focused simulations before a live-animal anesthesia encounter demonstrated significant improvements in anesthesia operational performance and improved patient safety.
To err is human: use of simulation to enhance training and patient safety in anaesthesia
British Journal of Anaesthesia, 2017
Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. As a profession, we are well versed in the development and utilization of improvement techniques and technologies that prioritize high-quality, safe care for patients. This article focuses on one particular domain of patient safety in which anaesthetists have been pre-eminent, the use of simulation in training to improve both professional capabilities and patient safety in anaesthetic practice. This review considers the impact of error in health care; the role of anaesthetists in promoting simulation-based education for the development of clinical skills and improved teamwork; and their role in disseminating human factors and quality improvement science to enhance safety in the clinical workplace. Finally, we consider our position at the vanguard of developments in patient safety and how the profession should continue to pursue a leadership role in the application of simulation-based interventions to training and systems design across health care.
A Simulation-Based Acute Skills Performance Assessment for Anesthesia Training
Anesthesia and Analgesia, 2005
In an earlier study, trained raters provided reliable scores for a simulation-based anesthesia acute care skill assessment. In this study, we used this acute care skill evaluation to measure the performance of student nurse anesthetists and resident physician trainees. The performance of these trainees was analyzed to provide data about acute care skill acquisition during training. Group comparisons provided information about the validity of the simulated exercises. A set of six simulationbased acute care exercises was used to evaluate 43 anesthesia trainees (28 residents [12 junior and 16 senior] and 15 student nurse anesthetists). Six raters scored the participants on each exercise using either a detailed checklist, key-action items, or a global rating. Trainees with the most education and clinical experience (i.e., senior residents) received higher scores on the simulation scenarios, providing some evidence to support the validity of the multi-scenario assessment. Trainees varied markedly in ability depending on the content of the exercise. In general, anesthesia providers demonstrated similar aptitude in managing each of the six simulated events. Most participants effectively managed ventricular tachycardia, but postoperative events such as anaphylaxis and stroke were more difficult for all trainees to promptly recognize and treat. Training programs could use a simulation-based multiple encounter evaluation to measure provider skill in acute care.
Performance of Residents and Anesthesiologists in a Simulation-based Skill Assessment
Anesthesiology, 2007
Background: Anesthesiologists and anesthesia residents are expected to acquire and maintain skills to manage a wide range of acute intraoperative anesthetic events. The purpose of this study was to determine whether an inventory of simulated intraoperative scenarios provided a reliable and valid measure of anesthesia residents' and anesthesiologists' skill.
Anesthesia & Analgesia, 2009
BACKGROUND: Anesthesiologists and certified registered nurse anesthetists (CRNAs) must acquire the skills to recognize and manage a variety of acute intraoperative emergencies. A simulation-based assessment provides a useful and efficient means to evaluate these skills. In this study, we evaluated and compared the performance of board-certified anesthesiologists and CRNAs managing a set of simulated intraoperative emergencies. METHODS: We enrolled 26 CRNAs and 35 board-certified anesthesiologists in a prospective, randomized, single-blinded study. These 61 specialists each managed 8 of 12 randomly selected, scripted, intraoperative simulation exercises. Participants were expected to recognize and initiate appropriate therapy for intraoperative events during a 5-min period. Two primary raters scored 488 simulation exercises (61 participants ϫ 8 encounters). RESULTS: Anesthesiologists achieved a modestly higher mean overall score than CRNAs (66.6% Ϯ 11.7 [range ϭ 41.7%-86.7%] vs 59.9% Ϯ 10.2 [range ϭ 38.3%-80.4%] P Ͻ 0.01). There were no significant differences in performance between groups on individual encounters. The raters were consistent in their identification of key actions. The reliability of the eight-scenario assessment, with two raters for each scenario, was 0.80. CONCLUSION: Although anesthesiologists, on average, achieved a modestly higher overall score, there was marked and similar variability in both groups. This wide range suggests that certification in either discipline may not yield uniform acumen in management of simulated intraoperative emergencies. In both groups, there were practitioners who failed to diagnose and treat simulated emergencies. If this is reflective of clinical practice, it represents a patient safety concern. Simulationbased assessment provides a tool to determine the ability of practitioners to respond appropriately to clinical emergencies. If all practitioners could effectively manage these critical events, the standard of patient care and ultimately patient safety could be improved.