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Wegner M, Dusse F, Beeser F, Leister N, Lefarth M, Finke SR, Böttiger BW, Dorweiler B, Stoll SE. Comparing Simulation Training of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Using Conventional Versus 3D Printed Simulators (TRAC-Sim Study). J Intensive Care Med 2024; 39:820-828. [PMID: 38403970 DOI: 10.1177/08850666241232918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background: Individual implementation rate of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) varies among intensivists. Simulation training (ST) can increase the safety of medical procedures by reducing stress levels of the performing team. The aim of this study was to evaluate the benefit of ST in PDT regarding procedural time, quality of performance, and percepted feelings of safety of the proceduralist and to compare conventional simulators (CSIM) with simulators generated from 3D printers (3DSIM). Methods: We conducted a prospective, single-center, randomized, blinded cross-over study comparing the benefit of CSIM versus 3DSIM for ST of PDT. Participants underwent a standardized theoretical training and were randomized to ST with CSIM (group A) or 3DSIM (group B). After ST, participants' performance was assessed by two blinded examiners on a porcine trachea regarding time required for successful completion of PDT and correct performance (assessed by a performance score). Percepted feelings of safety were assessed before and after ST. This was followed by a second training and second assessment of the same aspects with crossed groups. Results: 44 participants were included: 24 initially trained with CSIM (group A) and 20 with 3DSIM (group B). Correctness of the PDT performance increased significantly in group B (p < .01) and not significantly in group A (p = .14). Mean procedural time required for performing a PDT after their second ST compared to the first assessment (p < .01) was lower with no difference between group A and group B and irrespective of the participants' previous experience regarding PDT, age, and sex. Moreover, percepted feelings of safety increased after the first ST in both groups (p < .001). Conclusions: ST can improve procedural skills, procedural time, and percepted feelings of safety of the proceduralist in simulated PDT.
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Affiliation(s)
- Moritz Wegner
- Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Finnard Beeser
- Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Marian Lefarth
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Simon-Richard Finke
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sandra Emily Stoll
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Kraemer LS, Lopreiato J, McMurray H, Jeyarajah T, Dampman R, Raiciulescu S, Capo Dosal G, Jaffe E, Switzer J, Bowyer M. Retention of En Route Cricothyroidotomy Skills in Novice Providers Following a Simulation-Based Mastery Learning Curriculum. Mil Med 2024; 189:e2184-e2191. [PMID: 38651572 DOI: 10.1093/milmed/usae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/15/2023] [Accepted: 03/03/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment. MATERIALS AND METHODS This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist. RESULTS There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38-31.07 seconds; 6 months: median 36.33, interquartile range 31.59-55.22 seconds; 12 months: median 49.50, interquartile range 41.75-60.75 seconds; 24 months: median 38.79, interquartile range 30.20-53.08 seconds; P < .0001, P < .0001, P = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50-10.00; 6 months: median 8.00/10, interquartile range 6.75-9.00; 12 months: median 8.00/10, interquartile range 6.75-9.25; P < .0001, P < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50-10.00; 24 months: 10.00/10, interquartile range 9.00-10.00; P= .125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria. CONCLUSIONS This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency.
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Affiliation(s)
- Laura S Kraemer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- General Surgery Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Joseph Lopreiato
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Haana McMurray
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Ophthalmology Department, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Theepica Jeyarajah
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc (HJF), Bethesda, MD 20817, USA
| | - Rachel Dampman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc (HJF), Bethesda, MD 20817, USA
| | - Sorana Raiciulescu
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Gerardo Capo Dosal
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Family Medicine Department, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Edward Jaffe
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Anesthesiology Department, George Washington University, Washington, DC 20037, USA
| | - Julia Switzer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Internal Medicine Department, JBSA-Fort Sam Houston, San Antonio, TX 78234-7823, USA
| | - Mark Bowyer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Didion N, Pohlmann F, Pirlich N, Wittenmeier E, Jänig C, Wollschläger D, Griemert EV. Favour the best in case of emergency cricothyroidotomy-a randomized cross-over trial on manikin focused training and simulation of common devices. PeerJ 2024; 12:e17788. [PMID: 39193513 PMCID: PMC11348895 DOI: 10.7717/peerj.17788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/30/2024] [Indexed: 08/29/2024] Open
Abstract
Background Performing an emergency cricothyroidotomy (EC) is extremely challenging, the devices used should be easy to handle and the selected technique reliable. However, there is still an ongoing debate concerning the most superior technique. Methods Three different techniques were compared using a standardized, simulated scenario regarding handling, performing, training and decision making: The scalpel-bougie technique (SBT), the surgical anatomical preparation technique (SAPT) and the Seldinger technique (ST). First, anaesthesia residents and trainees, paramedics and medical students (each group n = 50) performed a cricothyroidotomy randomly assigned with each of the three devices on a simulator manikin. The time needed for successful cricothyroidotomy was the primary endpoint. Secondary endpoints included first-attempt success rate, number of attempts and user-satisfaction. The second part of the study investigated the impact of prior hands-on training on both material selection for EC and on time to decision-making in a simulated "cannot intubate cannot ventilate" situation. Results The simulated scenario revealed that SBT and SAPT were significantly faster than percutaneous EC with ST (p < 0.0001). Success rate was 100% for the first attempt with SBT and SAPT. Significant differences were found with regard to user-satisfaction between individual techniques (p < 0.0001). In terms of user-friendliness, SBT was predominantly assessed as easy (87%). Prior training had a large impact regarding choice of devises (p < 0.05), and time to decision making (p = 0.05; 180 s vs. 233 s). Conclusion This study supports the use of a surgical technique for EC and also a regular training to create familiarity with the materials and the process itself.The trial was registered before study start on 11.11.2018 at ClinicalTrials.gov (NCT: 2018-13819) with Nicole Didion as the principal investigator.
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Affiliation(s)
- Nicole Didion
- Department of Anaesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Fabian Pohlmann
- Department of Anaesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Nina Pirlich
- Department of Anaesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Eva Wittenmeier
- Department of Anaesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Christoph Jänig
- Department of Anaesthesiology and Critical Care Medicine, Central hospital of the German armed forces, Koblenz, Rhineland-Palatinate, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Eva-Verena Griemert
- Department of Anaesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Rhineland-Palatinate, Germany
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Cosgrave C, Anakin M, Blyth P, Baillie L, Beck S. Impact of an educational intervention utilising a three-dimensional-printed model for ultrasound-guided intra-articular injections of the dislocated shoulder. Emerg Med Australas 2024. [PMID: 39091126 DOI: 10.1111/1742-6723.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/26/2024] [Accepted: 07/06/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Intra-articular injection of local anaesthetic provides safe and effective analgesia for patients with shoulder dislocation. We designed a three-dimensional-printed ultrasound model of the shoulder to educate ED clinicians on use of this technique. We aimed to evaluate the impact of a 1-h training session using this model on participants' knowledge, skills and clinical practice. METHODS This was a prospective study of the clinicians working at two EDs in New Zealand. Participants (n = 20) took part in a 1-h educational session. We tested participants' performance before the session, afterwards and at 3 months using a 10-point objective structured clinical examination. We reviewed clinical records to determine whether there was increased utilisation of this technique among ED patients before and after the training. RESULTS There was improvement in participants' OCSE performance (median pre-training score = 4.00, median 3-month post-training score = 7.00, P = 0.044) and self-reported competence and knowledge, which were sustained to the end of the study. There was increased use of intra-articular injection among ED patients with shoulder dislocation: 2 of 68 patients (3%) before and 11 of 76 patients (14.5%) after the study. Notably, most were performed by clinicians who did not take part in the study (n = 9). CONCLUSION A 1-h training session using a three-dimensional-printed model improved participants objective structured clinical examination performance in ultrasound-guided injection of the shoulder joint. Although there was minimal change in the practice of participating clinicians, overall use of the procedure increased.
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Affiliation(s)
- Conor Cosgrave
- Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | - Megan Anakin
- Pharmacy Education at the Sydney School of Pharmacy, The University of Sydney Pharmacy School, Sydney, New South Wales, Australia
| | - Phil Blyth
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Louisa Baillie
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sierra Beck
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Emergency Department, Dunedin Hospital, Dunedin, New Zealand
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Phillips K, Sanders J, Warren LE. UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey. Midwifery 2024; 132:103952. [PMID: 38442530 DOI: 10.1016/j.midw.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/21/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
AIM This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.
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Affiliation(s)
- K Phillips
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom.
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
| | - L E Warren
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
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Kishimoto N, Ujita T, Tran SD, Sanuki T, Seo K. Simulation training for medical emergencies: Evaluation of dentists' long-term learning skills and confidence. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:689-697. [PMID: 38379393 DOI: 10.1111/eje.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/31/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION As the population ages and more patients experience medical emergencies during dental treatments, dentists must competently and confidently manage these situations. We developed a simulation training course for medical emergencies in the dental setting using an inexpensive vital sign simulation app for smartphones/tablets without the need for an expensive simulator. However, the duration for which this effect is maintained is unclear. This study was performed to evaluate the long-term educational effect at 3, 6, and 12 months after taking the course. MATERIALS AND METHODS Thirty-nine dental residents participated in this course. Scenarios included vasovagal syncope, anaphylaxis, hyperventilation syndrome, and acute coronary syndrome, each of which the participants had to diagnose and treat. The participants were evaluated using a checklist for anaphylaxis diagnosis and treatment skills immediately after and 3, 6, and 12 months after the course. The participants were also surveyed about their confidence in diagnosing and treating these conditions by questionnaire before, immediately after, and 3, 6, and 12 months after the course. RESULTS The checklist scores for anaphylaxis were significantly lower at 3, 6, and 12 months after the course than immediately after the course. The percentage of participants who provided a correct diagnosis and appropriate treatment for vasovagal syncope, hyperventilation syndrome, and acute coronary syndrome was lower at all reassessments than immediately after the course. CONCLUSION Because medical emergency management skills and confidence declined within 3 months, it would be useful to introduce a refresher course approximately 3 months after the initial course to maintain skills and confidence.
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Affiliation(s)
- Naotaka Kishimoto
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tomoaki Ujita
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Takuro Sanuki
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Kenji Seo
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Ryason A, Xia Z, Jackson C, Wong VT, Li H, De S, Jones SB. Validation of a Virtual Simulator With Haptic Feedback for Endotracheal Intubation Training. Simul Healthc 2024; 19:122-130. [PMID: 36598824 PMCID: PMC10314962 DOI: 10.1097/sih.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Endotracheal intubation (ETI) is a procedure that varies in difficulty because of patient characteristics and clinical conditions. Existing physical simulators do not encompass these variations. The Virtual Airway Skills Trainer for Endotracheal Intubation (VAST-ETI) was developed to provide different patient characteristics and high-fidelity haptic feedback to improve training. METHODS We demonstrate the effectiveness of VAST-ETI as a training and evaluation tool for ETI. Construct validation was evaluated by scoring the performance of experts ( N = 15) and novices ( N = 15) on the simulator to ensure its ability to distinguish technical proficiency. Convergent and predictive validity were evaluated by performing a learning curve study, in which a group of novices ( N = 7) were trained for 2 weeks using VAST-ETI and then compared with a control group ( N = 9). RESULTS The VAST-ETI was able to distinguish between expert and novice based on mean simulator scores ( t [88] = -6.61, P < 0.0005). When used during repeated practice, individuals demonstrated a significant increase in their score on VAST-ETI over the learning period ( F [11,220] = 7206, P < 0.001); however when compared with a control group, there was not a significant interaction effect on the simulator score. There was a significant difference between the simulator-trained and control groups ( t [12.85] = -2.258, P = 0.042) when tested in the operating room. CONCLUSIONS Our results demonstrate the effectiveness of virtual simulation with haptic feedback for assessing performance and training of ETI. The simulator was not able to differentiate performance between more experienced trainees and experts because of limits in simulator difficulty.
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Affiliation(s)
- Adam Ryason
- From the Rensselaer Polytechnic Institute (A.R., H.L., S.D.), Troy, NY; Huazhong University of Science and Technology (Z.X.), Wuhan, People's Republic of China; Beth Israel Deaconess Medical Center (C.J., V.T.W.), Boston, MA; and Albany Medical College (S.B.J.), Albany, NY
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Zhou Y, Gao H, Wang Q, Zhi J, Liu Q, Xia W, Duan Q, Yang D. Impact of simulation-based training on bougie-assisted cricothyrotomy technique: a quasi-experimental study. BMC MEDICAL EDUCATION 2024; 24:356. [PMID: 38553688 PMCID: PMC10981348 DOI: 10.1186/s12909-024-05285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Cricothyrotomy is a lifesaving surgical technique in critical airway events. However, a large proportion of anesthesiologists have little experience with cricothyrotomy due to its low incidence. This study aimed to develop a multisensory, readily available training curriculum for learning cricothyrotomy and evaluate its training effectiveness. METHODS Seventy board-certificated anesthesiologists were recruited into the study. Participants first viewed an instructional video and observed an expert performing the bougie-assisted cricothyrotomy on a self-made simulator. They were tested before and after a one-hour practice on their cricothyrotomy skills and evaluated by a checklist and a global rating scale (GRS). Additionally, a questionnaire survey regarding participants' confidence in performing cricothyrotomy was conducted during the training session. RESULTS The duration to complete cricothyrotomy was decreased from the pretest (median = 85.0 s, IQR = 72.5-103.0 s) to the posttest (median = 59.0 s, IQR = 49.0-69.0 s). Furthermore, the median checklist score was increased significantly from the pretest (median = 30.0, IQR = 27.0-33.5) to the posttest (median = 37.0, IQR = 35.5-39.0), as well as the GRS score (pretest median = 22.5, IQR = 18.0-25.0, posttest median = 32.0, IQR = 31.0-33.5). Participants' confidence levels in performing cricothyrotomy also improved after the curriculum. CONCLUSION The simulation-based training with a self-made simulator is effective for teaching anesthesiologists to perform cricothyrotomy.
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Affiliation(s)
- Ying Zhou
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Huibin Gao
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Qianyu Wang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Juan Zhi
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Weipeng Xia
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Qirui Duan
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China.
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Petersen JA, Bray L, Østergaard D. Continuing professional development (CPD) for anesthetists: A systematic review. Acta Anaesthesiol Scand 2024; 68:2-15. [PMID: 37432773 DOI: 10.1111/aas.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND In accordance with the focus on patient safety and quality in healthcare, continuing professional development (CPD) has received increasing levels of attention as a means to ensure physicians maintain their clinical competencies and are fit to practice. There is some evidence of a beneficial effect of CPD, though few studies have evaluated its effect within anesthesia. The primary aim of this systematic review was to establish which CPD activities anesthetists are engaged in and their effectiveness. The secondary aim was to explore which methods are employed to evaluate anesthetists' clinical performance. METHODS Databases searched: Medline, Embase and Web of Science, in May 2023. Additional papers were identified through searching the references of included studies. Eligible studies included anesthetists, either exclusively or combined with other healthcare professionals, who underwent a learning activity or assessment method as part of a formalized CPD program or a stand-alone activity. Non-English language studies, non-peer reviewed studies and studies published prior to 2000 were excluded. Eligible studies were quality assessed and narratively synthesized, with results presented as descriptive summaries. RESULTS A total of 2112 studies were identified, of which 63 were eligible for inclusion, encompassing more than 137,518 participants. Studies were primarily of quantitative design and medium quality. Forty-one studies reported outcomes of single learning activities, whilst 12 studies investigated different roles of assessment methods in CPD and ten studies evaluated CPD programs or combined CPD activities. A 36 of the 41 studies reported positive effects of single learning activities. Investigations of assessment methods revealed evidence of inadequate performance amongst anesthetists and a mixed effect of feedback. Positive attitudes and high levels of engagement were identified for CPD programs, with some evidence of a positive impact on patient/organizational outcomes. DISCUSSION Anesthetists are engaged in a variety of CPD activities, with evidence of high levels of satisfaction and a positive learning effect. However, the impact on clinical practice and patient outcomes remains unclear and the role of assessment is less well-defined. There is a need for further, high-quality studies, evaluating a broader range of outcomes, in order to identify which methods are most effective to train and assess specialists in anesthesia.
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Affiliation(s)
- John Asger Petersen
- Department of Day Case Surgery, Copenhagen University Hospital - Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Lucy Bray
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Nielsen MS, Lundorff SH, Hansen PM, Nielsen BU, Andersen SAW, Konge L, Nielsen AB, Brøchner AC. Anesthesiologists' skills in emergency cricothyroidotomy mandate a brush-up training after 3 months-A randomized controlled trial. Acta Anaesthesiol Scand 2024; 68:91-100. [PMID: 37729943 DOI: 10.1111/aas.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND In the Difficult Airway Society's 2015 "cannot intubate, cannot oxygenate" guideline, the emergency cricothyroidotomy is the final option when managing an unanticipated difficult airway. How often training for maintenance of this skill is required for anesthesiologists remains unknown. We aimed to assess if specialist-trained anesthesiologists' skills improved from a brush-up intervention and if skills were retained after 3 months. METHODS In this multicenter, randomized, controlled trial, participants were randomized to either a simulation-based brush-up or no brush-up. Both groups performed a mannequin-based technical skills emergency cricothyroidotomy test twice and were assessed by a blinded rater using a structured assessment tool that included time, positioning, palpation, appropriate employment of instruments, and stepwise progression. After 3 months of non-training, participants completed identical tests of retention. RESULTS A total of 54 anesthesiologists were included from three hospitals in the Region of Southern Denmark. Thirty-seven percent of the participants had received skills training in emergency cricothyroidotomy in the prior 12 months. The intervention group (N = 27) performed better in the initial tests, with a mean time of 51.5 s (SD = 10.82), a total score per minute of 15.9 points (SD = 4.91), and 93% passing both initial tests compared to the control group (N = 27) with a mean time of 76.8 s (SD = 35.82), a total score per minute of 6.6 (SD = 4.68) and only 15% passing both initial tests. The intervention group managed to retain overall performance in retention tests in terms of performance time (48.9 s, p = .26), total score per minute (13.6 points, p = .094), and passing the tests (75%, p = .059). CONCLUSION Exposure to simulation-based brush-up training in emergency cricothyroidotomy improved anesthesiologists' technical performance and was overall retained after 3 months. Some loss of skill concerning specific items was observed, highlighting the need for regular training in emergency cricothyroidotomy. Simulation-based training should be prioritized to improve and maintain technical skills in infrequent high-stakes procedures.
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Affiliation(s)
- Martine S Nielsen
- Department of Anaesthesiology and Intensive Care, Lillebaelt University Hospital, Kolding, Denmark
- SimC - Simulation Center, Odense University Hospital, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Simon H Lundorff
- Department of Anaesthesiology and Intensive Care, Lillebaelt University Hospital, Kolding, Denmark
| | - Peter Martin Hansen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark
- Danish Air Ambulance, Aarhus, Denmark
| | - Bjørn U Nielsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Steven A W Andersen
- Department of Otorhinolaryngology - Head and Neck Surgery, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for HR & Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for HR & Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Anders B Nielsen
- SimC - Simulation Center, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne C Brøchner
- Department of Anaesthesiology and Intensive Care, Lillebaelt University Hospital, Kolding, Denmark
- Department of Regional Health Research, Region of Southern Denmark, Odense, Denmark
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11
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Turner JS, Stewart LK, Hybarger AC, Ellender TJ, Stepsis TM, Bartkus EA, Garverick P, Cooper DD. An investigation into emergency medicine resident cricothyrotomy competency: Is three the magic number? AEM EDUCATION AND TRAINING 2023; 7:e10917. [PMID: 37997589 PMCID: PMC10664393 DOI: 10.1002/aet2.10917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/25/2023]
Abstract
Objectives Cricothyrotomy is a high-stakes emergency procedure. Because the procedure is rare, simulation is often used to train residents. The Accreditation Council for Graduate Medical Education (ACGME) requires performance of three cricothyrotomies during residency, but the optimal number of training repetitions is unknown. Additional repetitions beyond three could increase proficiency, though it is unknown whether there is a threshold beyond which there is no benefit to additional repetition. The objective of this study was to establish a minimum number of simulated cricothyrotomy attempts beyond which additional attempts did not increase proficiency. Methods This was a prospective, observational study conducted over 3 years at the simulation center of an academic emergency medicine residency program. Participants were residents participating in a cricothyrotomy training as part of a longitudinal airway curriculum course. The primary outcome was time to successful completion of the procedure as first-year residents. Secondary outcomes included time to completion as second- and third-year residents. Procedure times were plotted as a function of attempt number. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and correlation analysis. Preprocedure surveys collected further data regarding procedure experience, confidence, and comfort. Results Sixty-nine first-year residents participated in the study. Steady improvement in time to completion was seen through the first six attempts (from a mean of 75 to 41 sec), after which no further significant improvement was found. Second- and third-year residents initially demonstrated slower performance than first-year residents but rapidly improved to surpass their first-year performance. Resident mean times at five attempts were faster with each year of residency (first-year 48 sec, second-year 30 sec, third-year 24 sec). There was no statistically significant correlation between confidence and time to complete the procedure. Conclusions Additional repetition beyond the ACGME-endorsed three cricothyrotomy attempts may help increase proficiency. Periodic retraining may be important to maintain skills.
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Affiliation(s)
- Joseph S. Turner
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lauren K. Stewart
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Andrew C. Hybarger
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Timothy J. Ellender
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Tyler M. Stepsis
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Edward A. Bartkus
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Paul Garverick
- Western Michigan University, Homer Stryker M.D. School of MedicineKalamazooMichiganUSA
| | - Dylan D. Cooper
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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12
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Rogers-Vizena CR, Saldanha FYL, Sideridis GD, Allan CK, Livingston KA, Nussbaum L, Weinstock PH. High-Fidelity Cleft Simulation Maintains Improvements in Performance and Confidence: A Prospective Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:1859-1867. [PMID: 37679288 DOI: 10.1016/j.jsurg.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE High-fidelity simulation has a growing role in plastic surgical education. This study tests the hypothesis that cleft lip repair simulation followed by structured debriefing improves performance and self-confidence and that gains are maintained. DESIGN Prospective, single-blinded interventional study with repeated measures. Trainees performed cleft lip repair on a high-fidelity simulator followed by debriefing, immediately completed a second repair, and returned 3 months later for a third session. Anonymized simulation videos were rated using the modified Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair competency assessment tool (UCLR). Self-assessed cleft lip knowledge/confidence and procedural self-confidence were surveyed after each simulation. SETTING Boston Children's Hospital, a tertiary care academic hospital in Boston, MA, USA. PARTICIPANTS All trainees rotating through the study setting were eligible. Twenty-six participated; 21 returned for follow-up. RESULTS Significant improvements (p < 0.05) occurred between the first and second simulations for OSATS, UCLR, and procedural self-confidence. Significant improvement occurred between the second and third simulations cleft lip knowledge/confidence. Compared to the first simulation, improvements were maintained at the third simulation for all variables. Training level moderately correlated with score for UCLR for the first simulation (r = 0.55, p < 0.01), deteriorated somewhat with the second (r = 0.35, p = 0.08), and no longer corelated by the third (r = 0.02, p = 0.92). CONCLUSIONS Objective performance and subjective self-assessed knowledge and confidence improve with high-fidelity simulation plus structured debriefing and improvement is maintained. Differences in procedure-specific performance seen with increasing training level are reduced with simulation, suggesting it may accelerate knowledge and skill acquisition.
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Affiliation(s)
- Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Francesca Y L Saldanha
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Georgios D Sideridis
- Harvard Medical School, Boston, Massachusetts; Institutional Centers for Clinical & Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Catherine K Allan
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Katie A Livingston
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts
| | - Lisa Nussbaum
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Peter H Weinstock
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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13
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Baishya M, Garg R, Pangasa N, Khanna P. Impact of simulation practices on experienced anesthesiologists. J Anaesthesiol Clin Pharmacol 2023; 39:672-674. [PMID: 38269177 PMCID: PMC10805211 DOI: 10.4103/joacp.joacp_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 03/22/2022] [Accepted: 06/23/2022] [Indexed: 01/26/2024] Open
Affiliation(s)
- Madhurjya Baishya
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Rakesh Garg
- Anaesthesiology, Critical Care, Pain and Palliative Medicine, BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pangasa
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
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14
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Petrosoniak A, Sherbino J, Beardsley T, Bonz J, Gray S, Hall AK, Hicks C, Kim J, Mastoras G, McGowan M, Owen J, Wong AH, Monteiro S. Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice. CAN J EMERG MED 2023; 25:667-675. [PMID: 37326922 DOI: 10.1007/s43678-023-00531-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC). METHODS We conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test. RESULTS Immediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01). CONCLUSIONS There was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time.
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Affiliation(s)
- Andrew Petrosoniak
- Division of Emergency Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
| | - Jonathan Sherbino
- McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, ON, Canada
- Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Thomas Beardsley
- College of Medicine-Jacksonville, University of Florida, Gainesville, FL, USA
| | - James Bonz
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sara Gray
- Division of Emergency Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Christopher Hicks
- Division of Emergency Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Julie Kim
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - George Mastoras
- Division of Emergency Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Melissa McGowan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Julian Owen
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sandra Monteiro
- McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, ON, Canada
- Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, ON, Canada
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15
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Nielsen MS, Raben‐Levetzau FN, Andersen SAW, Wennervaldt K, Konge L, Nielsen AB. Retention of emergency cricothyroidotomy skills: A multicenter randomized controlled trial. AEM EDUCATION AND TRAINING 2023; 7:e10900. [PMID: 37529172 PMCID: PMC10387827 DOI: 10.1002/aet2.10900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
Objectives Emergency cricothyroidotomy is the final approach to establishing a secure airway. The procedure is acute and highly infrequent, making it difficult to achieve and maintain competence in the clinic. Simulation-based training in emergency cricothyroidotomy is effective but it is unknown how often training should be repeated to maintain skills. This study aimed to assess novices' retention of technical skills in emergency cricothyroidotomy after completing SBT. Methods Novices in emergency cricothyroidotomy completed a structured, simulation-based training program and were randomized to retention tests after 1, 3, or 6 months. Participants completed two emergency cricothyroidotomy tests at end-of-training and follow-up retention testing. Test performances were video recorded and evaluated by two experienced blinded raters using a structured assessment tool. Differences in the performances and the pass/fail rates were analyzed. Results Eighty-two medical students from two different Danish universities were included from April 2021 to February 2022. Paired t-tests showed skills decay significantly after 1 month (mean loss 6.7 points, p < 0.001). The mean loss of points, representing the difference in global score points, from the end-of-training to retention test was 6.7 points (95% confidence interval [CI] 4.5-8.8) for the 1-month group, 8.2 points (95% CI 5.8-10.0) for the 3-months group, and 9.9 points (95% CI 8.1-11.7) for the 6-months group. Six participants in both the 1-month group (23.1%) and the 3-month group (24%) passed the first retention test, but no one in the 6-months group had a passing performance. Conclusions Novices' technical skills performance in emergency cricothyroidotomy decay significantly already after 1 month. This initial loss of skill seems to be stable until 3 months, after which there is a further significant loss of skills. Recurring training should be implemented for the benefit of patient safety and outcomes.
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Affiliation(s)
- Martine Siw Nielsen
- SimC—Simulation CenterOdense University HospitalOdenseDenmark
- Open Patient Data Explorative Network (OPEN)Odense University HospitalOdenseDenmark
| | - Felix Nicolai Raben‐Levetzau
- Copenhagen Academy for Medical Education and Simulation, Center for HR & EducationThe Capital Region of DenmarkCopenhagenDenmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Academy for Medical Education and Simulation, Center for HR & EducationThe Capital Region of DenmarkCopenhagenDenmark
- Department of Otorhinolaryngology—Head and Neck SurgeryRigshospitaletCopenhagenDenmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for HR & EducationThe Capital Region of DenmarkCopenhagenDenmark
| | - Anders Bo Nielsen
- SimC—Simulation CenterOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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16
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Faulkner RA, Newnam K, Cooper N. High-Fidelity Simulation With Debriefing: Best Practice Education for Flight Nurses? Air Med J 2023; 42:169-173. [PMID: 37150570 DOI: 10.1016/j.amj.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/18/2022] [Accepted: 01/17/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE High-fidelity simulation with debriefing has been shown to be effective in maintaining high-risk, low-volume proficiencies in nursing. The purpose of this evidence-based practice project was to implement high-fidelity simulation with debriefing to measure improvements in flight nurse skill acuity and retention when performing intubations. METHODS This was a prospective evidence-based project conducted before and after a debriefing intervention that took place at HealthNet Aeromedical Services, Charleston, WV. Participants were flight nurses who were asked to intubate during a high-fidelity simulation session and participate in a debriefing session to reflect on their performance. They were then tested on 7-month skill retention. Eight subjects completed all stages of the study and were included in the analysis. RESULTS The mean ± standard deviation time to successful intubation predebriefing was 26.9 ± 11.9 seconds; for postdebriefing, it was 24.8 ± 5.8 seconds. The mean ± standard deviation checklist score before debriefing was 7.9 ± 0.4 points, whereas for postdebriefing it was 9.4 ± 0.7 points. CONCLUSION The implementation of debriefing after simulation improved the time to intubation and produced better clinical judgment and mastery while performing the intubation.
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Affiliation(s)
- Rachel A Faulkner
- Department of Graduate Nursing, University of Tennessee-Knoxville, Knoxville, TN.
| | - Katherine Newnam
- Department of Graduate Nursing, University of Tennessee-Knoxville, Knoxville, TN
| | - Nick Cooper
- Department of Education, HealthNet Aeromedical Services, Charleston, WV
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17
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Eidelman Pozin I, Zabida A, Friedman Z, Ivry M, Friedman M, Zahavi G, Yahav Shafir DD, Orkin D, Berkenstadt H. Simulation training results in performance retention for the management of airway fires: A prospective observational study. Anaesth Intensive Care 2023; 51:114-119. [PMID: 36688353 DOI: 10.1177/0310057x221113591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Given the severity of the consequences of operating room fires, it is recommended that every anaesthesiologist master fire safety protocols and periodically participate in operating room fire drills. The aim of the present study was to evaluate skill retention one year after an airway fire training programme. Anaesthesiology residents were evaluated using an airway fire simulation-based scenario one year after an educational programme that included a one-h long problem-based learning session, a simulation-based airway fire drill with debriefing, and a formal group discussion. The same simulation scenario was used for both the initial training and the one-year assessment. Thirty-eight anaesthesiology residents participated as pairs in the initial training programme. Of these, 36 participated in the evaluation a year later. Performance after one year was better than performance during the initial simulation. Time to removal of tracheal tube was 7.0 (4.0-12.8) s (median (interquartile range)) at the one-year assessment compared with 22.0 (18.5-52.5) s at the time of initial training (P < 0.001). Performance improvement was also demonstrated by a higher incidence of performance of crucial action items (cessation of airway gases, removal of sponges and pouring of saline), as well as shorter duration of time necessary to perform these tasks. After controlling the fire, the time to re-establish ventilation by bag-mask ventilation or intubation was shorter at one year: 18.0 (11.0-29.0 ) s, compared with initial training 54.0 s (36.2-69.8) s (P = 0.001). We conclude that skills are effectively retained for a year after an airway fire management training session.
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Affiliation(s)
- Inna Eidelman Pozin
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Zabida
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Zeev Friedman
- Department of Anaesthesia, Sinai Health System, University of Toronto, Toronto, Canada
| | - Michal Ivry
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Maria Friedman
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Guy Zahavi
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dana D Yahav Shafir
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dina Orkin
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Berkenstadt
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Rotin LE, Pavenski K, Petrosoniak A. Simulation-based medical education in transfusion medicine: Current state and future applications. Transfus Apher Sci 2023; 62:103628. [PMID: 36586811 DOI: 10.1016/j.transci.2022.103628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lianne E Rotin
- Adult Hematology Residency Program, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine, St. Michael's Hospital, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.
| | - Andrew Petrosoniak
- Department of Emergency Medicine, St. Michael's Hospital, Canada; Department of Medicine, University of Toronto, Canada
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19
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Tankard KA, Sharifpour M, Chang MG, Bittner EA. Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management. J Clin Med 2022; 11:6336. [PMID: 36362564 PMCID: PMC9656324 DOI: 10.3390/jcm11216336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 09/11/2023] Open
Abstract
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM is associated with significant morbidity and mortality. Evidence suggests that a dedicated airway response team (ART) can help mitigate the risks associated with EAM and provide a framework for airway management in acute settings. We review the risks and challenges related to EAM and describe strategies to improve patient care and outcomes via implementation of an ART.
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Affiliation(s)
- Kelly A. Tankard
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Milad Sharifpour
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA 90048, USA
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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20
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Ffrench-O'Carroll R, Sunderani Z, Preston R, Mayer U, Albert A, Chau A. Enhancing knowledge, skills, and comfort in providing anesthesia assistance during obstetric general anesthesia for operating room nurses: a prospective observational study. Can J Anaesth 2022; 69:1220-1229. [PMID: 35750971 DOI: 10.1007/s12630-022-02277-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Due to a nationwide shortage of anesthesia assistants, operating room nurses are often recruited to assist with the induction of obstetric general anesthesia (GA). We developed and administered a training program and hypothesized there would be significant improvements in knowledge and skills in anesthesia assistance during obstetric GA by operating room nurses following training with adequate retention at six months. METHODS Following informed consent, all operating room nurses at our institution were invited to participate in the study. Baseline knowledge of participants was assessed using a 14-item multiple choice questionnaire (MCQ), and skills were assessed using a 12-item checklist scored by direct observation during simulated induction of GA. Next, a 20-min didactic lecture followed by a ten-minute hands-on skills station were delivered. Knowledge and skills were immediately reassessed after training, and again at six weeks and six months. The primary outcomes of this study were adequate knowledge and skills retention at six months, defined as achieving ≥ 80% in MCQ and ≥ 80% in skills checklist scores and analyzed using longitudinal mixed-effects linear regression. RESULTS A total of 34 nurses completed the study at six months. The mean MCQ score at baseline was 8.9 (95% confidence interval [CI], 8.5 to 9.4) out of 14. The mean skills checklist score was 5.5 (95% CI, 4.9 to 6.1) out of 12. The mean comfort scores for assisting elective and emergency Cesarean deliveries were 3.6 (95% CI, 3.2 to 3.9) and 3.1 (95% CI, 2.7 to 3.5) out of 5, respectively. There was a significant difference in the mean MCQ and skills checklist scores across the different study periods (overall P value < 0.001). Post hoc pairwise tests suggested that, compared with baseline, there were significantly higher mean MCQ scores at all time points after the training program at six weeks (11.9; 95% CI, 11.4 to 12.4; P < 0.001) and at six months (12.0; 95% CI, 11.5 to 12.4; P < 0.001). DISCUSSION The knowledge and skills of operating room nurses in providing anesthesia assistance during obstetric GA at our institution were low at baseline. Following a single 30-min in-house, anesthesiologist-led, structured training program, scores in both dimensions significantly improved. Although knowledge improvements were adequately retained for up to six months, skills improvements decayed rapidly, suggesting that sessions should be repeated at six-week intervals, at least initially.
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Affiliation(s)
| | - Zahid Sunderani
- Department of Anesthesia, Rockyview General Hospital, Calgary, AB, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Roanne Preston
- Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Anthony Chau
- Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada. .,Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
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Truchot J, Boucher V, Li W, Martel G, Jouhair E, Raymond-Dufresne É, Petrosoniak A, Emond M. Is in situ simulation in emergency medicine safe? A scoping review. BMJ Open 2022; 12:e059442. [PMID: 36219737 PMCID: PMC9301797 DOI: 10.1136/bmjopen-2021-059442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED). DESIGN Scoping review. METHODS Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine. INFORMATION SOURCES MEDLINE, EMBASE, Cochrane and Web of Science. RESULTS A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes. CONCLUSION Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.
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Affiliation(s)
- Jennifer Truchot
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Emergency Department, CHU Cochin- Université de Paris, APHP, Paris, France
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
| | - Winny Li
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guillaume Martel
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Eva Jouhair
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Éliane Raymond-Dufresne
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Andrew Petrosoniak
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcel Emond
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
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Gent D, Kainth R. Simulation-based procedure training (SBPT) in rarely performed procedures: a blueprint for theory-informed design considerations. Adv Simul (Lond) 2022; 7:13. [PMID: 35527267 PMCID: PMC9079208 DOI: 10.1186/s41077-022-00205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
Simulation-based procedure training is now integrated within health professions education with literature demonstrating increased performance and translational patient-level outcomes. The focus of published work has been centered around description of such procedural training and the creation of realistic part-task models. There has been little attention with regards to design consideration, specifically around how simulation and educational theory should directly inform programme creation. Using a case-based approach in cardiology as an example, we present a blueprint for theory-informed simulation-based procedure training linking learning needs analysis and defining suitable objectives to matched fidelity. We press the importance of understanding how to implement and utilise task competence benchmarking in practice, and the role of feedback and debriefing in cycles of repeated practice. We conclude with evaluation and argue why this should be considered part of the initial design process rather than an after-thought following education delivery.
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Affiliation(s)
- David Gent
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
- St George's University Hospital NHS Foundation Trust, London, UK.
| | - Ranjev Kainth
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Simulation and Interactive Learning (SaIL) Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Emergency Subglottic Airway Training and Assessment of Skills Retention of Attending Anesthesiologists With Simulation Mastery-Based Learning. Anesth Analg 2022; 135:143-151. [PMID: 35147576 DOI: 10.1213/ane.0000000000005928] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although included within the American Society of Anesthesiologists difficult airway algorithm, the use of "invasive airway access" is rarely needed clinically. In conjunction with highly associated morbidity and liability risks, it is a challenge for the average anesthesiologist to develop and maintain competency. The advancement of high-fidelity simulators allows for practice of rarely encountered clinical scenarios, specifically those requiring invasive subglottic airway techniques. METHODS Sixty board-certified academic anesthesiologists were enrolled and trained in dyads in a simulation-based, mastery-based learning (MBL) course directed at 2 emergency airway subglottic techniques: transtracheal jet ventilation (TTJV) and bougie cricothyrotomy (BC). Performance metrics included: pretest, posttest, specific skill step error tracking, and 15-month period retest. All were pretested and trained once on the Melker cricothyrotomy (MC) kit. All pretest assessment, training, posttesting, and 15-month retesting were performed by a single expert clinical and educational airway management faculty member. RESULTS Initial testing showed a success rate of 14.8% for TTJV, 19.7% for BC, and 25% for MC. After mastery-based practice, all anesthesiologists achieved successful invasive airway placement with TTJV, BC, and MC. Repeated performance of each skill improved speed with zero safety breaches. BC was noted to be the fastest performed technique. Fifteen months later, retesting showed that 80.4% and 82.6% performed successful airway securement for TTJV and BC, respectively. For safety, average placement time and costs, MC was discarded after initial training results. CONCLUSIONS We discovered that only ~20% of practicing anesthesiologists were able to successfully place an invasive airway in a simulated life or death clinical setting. Using mobile simulation (training performed in department conference room) during a 2.5-hour session using mastery-based training pedagogy, we increased our success rate of invasive airway placement to 100%, while also increasing the successful speed to ventilation (TTJV, 32 seconds average; BC, 29 seconds average). Finally, we determined that there was a 15-month 80% retention rate of the airway skills learned, indicating that skills last at least a year before retraining is required using this training methodology.
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Lee A, Finstad A, Tipney B, Lamb T, Rahman A, Devenny K, Abou Khalil J, Kuziemsky C, Balaa F. OUP accepted manuscript. BJS Open 2022; 6:6555348. [PMID: 35348608 PMCID: PMC8963294 DOI: 10.1093/bjsopen/zrac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Human factors (HF) integration can improve patient safety in the operating room (OR), but the depth of current knowledge remains unknown. This study aimed to explore the content of HF training for the operative environment. Methods We searched six bibliographic databases for studies describing HF interventions for the OR. Skills taught were classified using the Chartered Institute of Ergonomics and Human Factors (CIEHF) framework, consisting of 67 knowledge areas belonging to five categories: psychology; people and systems; methods and tools; anatomy and physiology; and work environment. Results Of 1851 results, 28 studies were included, representing 27 unique interventions. HF training was mostly delivered to interdisciplinary groups (n = 19; 70 per cent) of surgeons (n = 16; 59 per cent), nurses (n = 15; 56 per cent), and postgraduate surgical trainees (n = 11; 41 per cent). Interactive methods (multimedia, simulation) were used for teaching in all studies. Of the CIEHF knowledge areas, all 27 interventions taught ‘behaviours and attitudes’ (psychology) and ‘team work’ (people and systems). Other skills included ‘communication’ (n = 25; 93 per cent), ‘situation awareness’ (n = 23; 85 per cent), and ‘leadership’ (n = 20; 74 per cent). Anatomy and physiology were taught by one intervention, while none taught knowledge areas under work environment. Conclusion Expanding HF education requires a broader inclusion of the entirety of sociotechnical factors such as contributions of the work environment, technology, and broader organizational culture on OR safety to a wider range of stakeholders.
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Affiliation(s)
- Alex Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Tyler Lamb
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Alvi Rahman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kirsten Devenny
- Saegis, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Jad Abou Khalil
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Craig Kuziemsky
- Office of Research Services and School of Business, MacEwan University, AB, Canada
| | - Fady Balaa
- Correspondence to: Fady Balaa, Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital – General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada (e-mail: )
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Howard M, Noppens R, Gonzalez N, Jones PM, Payne SM. Seven years on from the Canadian Airway Focus Group Difficult Airway Guidelines: an observational survey. Can J Anaesth 2021; 68:1331-1336. [PMID: 34231128 PMCID: PMC8259770 DOI: 10.1007/s12630-021-02056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Numerous clinical guidelines are available for management of the unanticipated difficult airway. It is unclear if practice recommendations are endorsed on regional, local, or individual levels. The objective of this observational study was to examine local and regional use of airway guidelines by anesthesiologists within a hospital partnership in Southwestern Ontario. METHODS Using a paper survey, distributed locally to consultant and trainee anesthesiologists in a tertiary hospital, we examined individual clinical and educational practices regarding guideline use in airway management. Respondents were asked to report which published guideline they used for unanticipated airway difficulty. The effectiveness of dissemination of the national Canadian airway guidelines-the Canadian Airway Focus Group (CAFG) Difficult Airway Guidelines-was examined. We invited anesthesia department heads within the regional hospital partnership to complete an electronic survey investigating departmental adoption of guidelines. RESULTS The response rate was 70% locally (79/112 anesthesiologists) and 52% regionally (11/21 department heads). Approximately 80% (64/79) of respondents reported using a formal clinical guideline if unanticipated difficulty with airway management was encountered. Seventy-two per cent of respondents (57/79) were aware of the published CAFG guidelines. Approximately 30% (16/51) of consultant anesthesiologists reported using the CAFG guidelines in clinical practice. Within the hospital partnership, 36% (4/11) of departments formally endorsed use of a specific airway management guideline. CONCLUSIONS Despite widespread awareness of the national CAFG Difficult Airway Guidelines, they are not widely adopted in clinical practice. Further research is warranted to explore barriers to adoption of airway management guidelines for both individual anesthesiologists and anesthesia departments.
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Affiliation(s)
- Malcolm Howard
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
| | - Ruediger Noppens
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
| | - Nelson Gonzalez
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
| | - Philip M Jones
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
| | - Sonja M Payne
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada.
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada.
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Hale C, Crocker J, Vanka A, Ricotta DN, McSparron JI, Huang GC. Cohort study of hospitalists' procedural skills: baseline competence and durability after simulation-based training. BMJ Open 2021; 11:e045600. [PMID: 34400443 PMCID: PMC8370503 DOI: 10.1136/bmjopen-2020-045600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Hospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months. DESIGN Prospective cohort study with pretraining and post-training measurements. SETTING Single, large, urban academic medical centre in the USA. PARTICIPANTS Twenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures. INTERVENTIONS One-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP). PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence. RESULTS At baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time. CONCLUSIONS Hospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.
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Affiliation(s)
- Caleb Hale
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Crocker
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anita Vanka
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jakob I McSparron
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Grace C Huang
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Bialka S, Copik M, Ubych A, Marciniak R, Smereka J, Szarpak L, Misiolek H. Effect of high-fidelity simulation on alpha-amylase activity and concentrations of secretory immunoglobulin class A, cortisol, and testosterone among medical students. Endocrine 2021; 73:431-438. [PMID: 33821392 PMCID: PMC8263411 DOI: 10.1007/s12020-021-02696-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/11/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE High-fidelity simulation calls heavily upon cognitive capacities and generates stress and anxiety. The objective of this prospective, observational study was to evaluate the degree of stress in medical students by measuring hormone levels during critical care classes. METHODS Overall, 55 students (senior years of medical faculty) of both sexes were divided into 5-person teams. Demographic data and information on diagnosed diseases, stimulants used, and previous experience in the field of medical simulation were collected with a personal questionnaire. Before starting the scenario (T0), after the end of the scenario (T1), and 120 min thereafter (T2), stress level was measured. For this purpose, systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate and blood oxygen saturation were evaluated. In addition, saliva was collected to determine alpha-amylase activity and the concentrations of secretory immunoglobulin class A, cortisol, and testosterone. RESULTS Among hemodynamic parameters, systolic and mean blood pressure and heart rate were significantly higher in T1 than in T0 and T2 time points (p < 0.05). Cortisol concentration was higher at T2 compared with T0 and T1. Alpha-amylase activity was highest at T1. Secretory immunoglobulin class A concentration was highest at T0, followed by T1 and then T2. These differences were not statistically significant. Testosterone concentration showed significantly higher values at T2 compared with T0 and T1 (p < 0.05). The analysis of team leaders vs. other members revealed significantly lower cortisol and alpha-amylase values in leaders (p < 0.05). CONCLUSIONS High-fidelity simulation is a useful education method in medical subjects, especially in cases where a mistake could produce serious or irreversible consequences. It can increase stress hormone concentrations and thus can be assumed effective as a learning aid even in senior-year students of medical faculty.
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Affiliation(s)
- Szymon Bialka
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Maja Copik
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Adam Ubych
- Center of Didactics and Medical Simulation, Medical University of Silesia, Katowice, Poland
| | - Radosław Marciniak
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek Smereka
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | | | - Hanna Misiolek
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Legoux C, Gerein R, Boutis K, Barrowman N, Plint A. Retention of Critical Procedural Skills After Simulation Training: A Systematic Review. AEM EDUCATION AND TRAINING 2021; 5:e10536. [PMID: 34099989 PMCID: PMC8166305 DOI: 10.1002/aet2.10536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE While short-term gains in performance of critical emergency procedures are demonstrated after simulation, long-term retention is relatively uncertain. Our objective was to determine whether simulation of critical emergency procedures promotes long-term retention of skills in nonsurgical physicians. METHODS We searched multiple electronic databases using a peer-reviewed strategy. Eligible studies 1) were observational cohorts, quasi-experimental or randomized controlled trials; 2) assessed intubation, cricothyrotomy, pericardiocentesis, tube thoracostomy, or central line placement performance by nonsurgical physicians; 3) utilized any form of simulation; and 4) assessed skill performance immediately after and at ≥ 3 months after simulation. The primary outcome was skill performance at or above a preset performance benchmark at ≥ 3 months after simulation. Secondary outcomes included procedural skill performance at 3, 6, and ≥ 12 months after simulation. RESULTS We identified 1,712 citations, with 10 being eligible for inclusion. Methodologic quality was moderate with undefined primary outcomes; inadequate sample sizes; and use of nonstandardized, unvalidated tools. Three studies assessed performance to a specific performance benchmark. Two demonstrated maintenance of the minimum performance benchmark while two demonstrated significant skill decay. A significant decline in the mean performance scores from immediately after simulation to 3, 6, and ≥ 12 months after simulation was observed in four of four, three of four, and two of five studies, respectively. Scores remained significantly above baseline at 3, 6, and ≥ 12 months after simulation in three of four, three of four, and four of four studies, respectively. CONCLUSION There were a limited number of studies examining the retention of critical skills after simulation training. While there was some evidence of skill retention after simulation, overall most studies demonstrated skill decline over time.
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Affiliation(s)
| | - Richard Gerein
- theChildren’s Hospital of Eastern Ontario (CHEO)University of OttawaOttawaOntarioCanada
- and theDepartment of PediatricsUniversity of OttawaOttawaOntarioCanada
- and theDepartment of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Kathy Boutis
- andThe Hospital for Sick Children and Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Nicholas Barrowman
- theChildren’s Hospital of Eastern Ontario (CHEO)University of OttawaOttawaOntarioCanada
- and theDepartment of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Amy Plint
- theChildren’s Hospital of Eastern Ontario (CHEO)University of OttawaOttawaOntarioCanada
- and theDepartment of PediatricsUniversity of OttawaOttawaOntarioCanada
- and theDepartment of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
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Battaglini D, Ionescu Maddalena A, Caporusso RR, Garofalo E, Bruni A, Bocci MG, Cingolani E, Giarratano A, Petrini F. Acquisition of skills in Critical Emergency Medicine: an experimental study on the SIAARTI Academy CREM experience. Minerva Anestesiol 2021; 87:1174-1182. [PMID: 34170097 DOI: 10.23736/s0375-9393.21.15427-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2019 the SIAARTI developed a seven-days course for residents, focused on critical emergency medicine (CREM) in a hostile environment, that grounds on simulation-based education and training with hands-on simulation, high-fidelity simulators and part-task trainers. This project aimed to evaluate the efficacy of this course in comparison to traditional learning programs in term of technical (TS) and non-technical (NTS) skills. We assessed the improvement in TS and NTS over time, and the ability to involve trainees in corporate activities. METHODS Three-hundred and twenty-seven trainees completed the study. Trainees were allocated into 3 groups: those who joined the SIAARTI-Academy-CREM course and received a study kit (SAKit, n=124), those who received only a study kit (Kit, n=108), and Control (n=95). Eighty-five tests were administered to investigate skills at 3 timepoints: T0=baseline, T1=post-training/kit, and T2=4-months later. RESULTS TS differed among groups (p<0.0001), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control), and T2 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control). NTS differed among groups (p=0.0406), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p=0.0337 vs Kit; p=0.0416 vs Control), and T2 (post-hoc comparison, p=0.0073 vs Kit; p=0.3308 vs Control). SA-Kit group significantly improved TS (p<0.0001) and NTS (p=0.0006) over time. Involvement in corporate activities of SAkit was significantly higher than Kit and Control (p=0.0012). CONCLUSIONS SA-Kit improvement in TS and NTS was higher than Kit and Control and was maintained over time. Participation in this course implemented participation in corporate activities among attendees.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy - .,Department of Medicine, University of Barcelona, Barcelona, Spain -
| | - Alessandra Ionescu Maddalena
- UOC Anestesia e Rianimazione, Polo Ospedaliero Balcolle ASL, Viterbo, Italy.,Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Istituto di Anestesiologia e Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del sacro Cuore, Rome, Italy
| | - Roberta R Caporusso
- Sezione anestesia e rianimazione, Dipartimento di Scienze mediche e chirurgiche, Università degli Studi di Foggia, Foggia, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Mater Domini University Hospital, Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, Mater Domini University Hospital, Catanzaro, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Istituto di Anestesiologia e Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del sacro Cuore, Rome, Italy
| | - Emiliano Cingolani
- Dipartimento di Emergenza Accettazione e delle Chirurgie specialistiche, UOSD Shock e Trauma, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Antonino Giarratano
- Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- Department of Anesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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Prospective Randomized Controlled Trial of Video- Versus Recall-Assisted Reflection in Simulation-Based Teaching on Acquisition and Retention of Airway Skills Among Trainees Intubating Critically Ill Patients. Crit Care Med 2021; 48:1265-1270. [PMID: 32618692 DOI: 10.1097/ccm.0000000000004448] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Conventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors. DESIGN Randomized control trial. Participants were randomized 1:1 to video-assisted reflection or recall-assisted reflection group. SETTING University-affiliated tertiary care center. SUBJECTS Junior critical care doctors. INTERVENTION Video-assisted reflection. MEASUREMENTS AND MAIN RESULTS All participants underwent simulation-based teaching of technical and nontechnical airway skills involved in managing a critically ill patient. These skills were assessed before, post-workshop, and in the following fourth week, by two independent blinded assessors using a validated scoring tool. Quality of debrief was assessed using a validated questionnaire. Repeated-measures analysis of variance was used to assess time and group interaction. Forty doctors were randomized. At baseline, the groups had similar airway experience (p = 0.34) and skill scores (p = 0.97). There was a significant interaction between study groups and changes over time for total skill scores (F[2, 37] = 4.06; p = 0.02). Although both the study groups had similar and significant improvement in total skills scores at the postworkshop assessment, the decline in total skills scores at delayed assessment (F[1, 38] = 5.64; p = 0.02) was significantly more in the recall-assisted reflection group when compared with the video-assisted reflection group. This resulted in lower mean skill scores in the recall-assisted reflection group when compared with the video-assisted reflection group in the delayed assessment (89.45 [19.32] vs 110.10 [19.54]; p < 0.01). Better retention was predominantly in the nontechnical skills. The perceived quality of debrief was similar between the two groups. CONCLUSION When compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.
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Hock SM, Shah SC, Perumalsamy PD, Sergel M. Comparison of Two Simulated Procedural Assessment Formats in Attending Emergency Physicians. Cureus 2021; 13:e14943. [PMID: 34123640 PMCID: PMC8189535 DOI: 10.7759/cureus.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Emergency physicians must be proficient at inserting central venous catheters and performing lumbar punctures to provide life-saving therapies to critically ill patients. An assessment of procedural skill is rarely performed after an emergency physician has completed residency. Current board certification exams for emergency medicine focus only on verbal descriptions of procedures to assess skill. We compared two methods of procedural skill assessment, simulated task trainer and verbal description, to assess the range of skill in central venous catheter insertion and lumbar punctures of emergency attending physicians at a large, urban, academic tertiary care institution. Methodology This is a prospective cohort study of simulated internal jugular central venous catheter insertion and lumbar puncture skill by emergency attending physicians on a task trainer versus verbal description. A total of 17 attending emergency medicine physicians consented to participate in the study during a yearly procedural skills session. For each subject, two expert raters used previously published checklists to assess procedural skill and give a global rating score. Results More checklist items were performed correctly on the task trainer than on verbal assessment for central line (task trainer = 78.4% ± 8.32% and verbal = 68.26% ± 8.9%) and lumbar puncture (task trainer = 85.57% ± 7.6% and verbal = 73.53%4 ± 10.34%) procedures, both with significant differences (p < 0.001). Of the participants, 82% strongly preferred the task trainer format to the verbal description assessment format. Conclusions The higher scores on the simulated format compared to the current verbal format imply that a shift towards simulated procedural assessment techniques may benefit examinees. More work is needed to determine if objective checklist scores for practicing attending emergency physicians correlate with subjective expert assessments of their procedural skills.
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Affiliation(s)
- Sara M Hock
- Department of Emergency Medicine, Rush University Medical Center, Chicago, USA
| | - Shital C Shah
- Department of Health Systems Management, College of Health Sciences, Rush University Medical Center, Chicago, USA
| | - Priya D Perumalsamy
- Department of Emergency Medicine, Cape Regional Medical Center, Cape May Court House, USA
| | - Michelle Sergel
- Department of Emergency Medicine, Cook County Health and Hospital System, Chicago, USA
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The evolution of a national, advanced airway management simulation-based course for anaesthesia trainees. Eur J Anaesthesiol 2021; 38:138-145. [PMID: 32675701 DOI: 10.1097/eja.0000000000001268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Needs analyses involving patient complaints and anaesthesiologists' confidence levels in difficult airway management procedures in Denmark have shown a need for training in both technical and non-technical skills. OBJECTIVE To provide an example of how to design, implement and evaluate a national simulation-based course in advanced airway management for trainees within a compulsory, national specialist training programme. DESIGN AND RESULTS A national working group, established by the Danish Society for Anaesthesiology and Intensive Care Medicine, designed a standardised simulation course in advanced airway management for anaesthesiology trainees based on the six-step approach. Learning objectives are grounded in the curriculum and analyses-of-needs (in terms of knowledge, skills and attitudes, including non-technical skills, which encompass the cognitive skills and social skills, necessary for safe and effective performance). A total of 28 courses for 800 trainees have been conducted. Evaluation has been positive and pre and posttests have indicated a positive effect on learning. CONCLUSION The course was successfully designed and implemented within the national training programme for trainees. Important factors for success were involvement of all stakeholders, thorough planning, selection of the most important learning objectives, the use of interactive educational methods and training of the facilitators.
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Building confidence to perform cricothyroidotomy: A task trainer-based training programme. Eur J Anaesthesiol 2021; 38:322-324. [PMID: 33538437 DOI: 10.1097/eja.0000000000001342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clark CM, Morgan BT, Schmitt D, Harman RJ, Goode V. Improving Emergency Cricothyroidotomies: Simulation-Based Training for Critical Care Providers. Crit Care Nurs Q 2021; 44:203-213. [PMID: 33595967 DOI: 10.1097/cnq.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses skill proficiency of providers related to emergency cricothyroidotomies. Various techniques to improve procedural skills were studied. Accurate identification of the cricothyroid membrane via palpation remained consistently inadequate. High-fidelity simulation including the use of human cadavers may be the preferred method of skill training for crisis management. The authors emphasize that additional research is needed regarding a method for rapid cricothyroid membrane identification as well as needle cricothyroidotomy versus surgical airway on cadavers. More consistent training will enable emergency care providers to perform this rare but lifesaving skill.
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Affiliation(s)
- Clayton M Clark
- Duke University Nurse Anesthesia Program, Duke University School of Nursing, Durham, North Carolina (Drs Clark, Morgan, and Goode); Department of Evolutionary Anthropology, Duke University, Durham, North Carolina (Dr Schmitt); Department of Anesthesiology, Duke University Hospital, Durham, North Carolina (Dr Harman); and Johns Hopkins University School of Nursing, Baltimore, Maryland (Dr Goode)
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Silverio SA, Wallace H, Gauntlett W, Berwick R, Mercer S, Morton B, Rogers SN, Sandars JE, Groom P, Brown JM. Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training. PLoS One 2021; 16:e0249070. [PMID: 33755714 PMCID: PMC7987190 DOI: 10.1371/journal.pone.0249070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
The time-critical 'can't intubate, can't oxygenate' [CICO] emergency post-induction of anaesthesia is rare, but one which, should it occur, requires Anaesthetists to perform rapid emergency front of neck access [FONA] to the trachea, restoring oxygenation, and preventing death or brain hypoxia. The UK Difficult Airway Society [DAS] has directed all Anaesthetists to be trained with surgical cricothyroidotomy [SCT] as the primary emergency FONA method, sometimes referred to as 'Cric' as a shorthand. We present a longitudinal analysis using a classical approach to Grounded Theory methodology of ten Specialist Trainee Anaesthetists' data during a 6-month training programme delivered jointly by Anaesthetists and Surgeons. We identified with a critical realist ontology and an objectivist epistemology meaning data interpretation was driven by participants' narratives and accepted as true accounts of their experience. Our theory comprises three themes: 'Identity as an Anaesthetist'; 'The Role of a Temporary Surgeon'; and 'Training to Reconcile Identities', whereby training facilitated the psychological transition from a 'bloodless Doctor' (Anaesthetist) to becoming a 'temporary Surgeon'. The training programme enabled Specialist Trainees to move between the role of control and responsibility (Identity as an Anaesthetist), through self-described 'failure' and into a role of uncertainty about one's own confidence and competence (The Role of a Temporary Surgeon), and then return to the Anaesthetist's role once the airway had been established. Understanding the complexity of an intervention and providing a better insight into the training needs of Anaesthetic trainees, via a Grounded Theory approach, allows us to evaluate training programmes against the recognised technical and non-technical needs of those being trained.
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Affiliation(s)
- Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Elizabeth Garrett Anderson Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Hilary Wallace
- Anaesthesia and Theatres Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - William Gauntlett
- The Jackson Rees Department of Anaesthesia, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Berwick
- Anaesthesia and Theatres Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Pain Research Institute, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Simon Mercer
- Anaesthesia and Theatres Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Medical Education Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Critical Care Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Simon N. Rogers
- Oral and Maxillofacial Surgery Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Health Research Institute, Faculty of Health & Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - John E. Sandars
- Health Research Institute, Faculty of Health & Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Peter Groom
- Anaesthesia and Theatres Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Jeremy M. Brown
- Health Research Institute, Faculty of Health & Social Care, Edge Hill University, Ormskirk, United Kingdom
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Situ-LaCasse E, Acuña J, Huynh D, Amini R, Irving S, Samsel K, Patanwala AE, Biffar DE, Adhikari S. Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules? BMC MEDICAL EDUCATION 2021; 21:175. [PMID: 33743680 PMCID: PMC7980807 DOI: 10.1186/s12909-021-02612-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/11/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Point-of-care ultrasound is becoming a ubiquitous diagnostic tool, and there has been increasing interest to teach novice practitioners. One of the challenges is the scarcity of qualified instructors, and with COVID-19, another challenge is the difficulty with social distancing between learners and educators. The purpose of our study was to determine if ultrasound-naïve operators can learn ultrasound techniques and develop the psychomotor skills to acquire ultrasound images after reviewing SonoSim® online modules. METHODS This was a prospective study evaluating first-year medical students. Medical students were asked to complete four SonoSim® online modules (aorta/IVC, cardiac, renal, and superficial). They were subsequently asked to perform ultrasound examinations on standardized patients utilizing the learned techniques/skills in the online modules. Emergency Ultrasound-trained physicians evaluated medical students' sonographic skills in image acquisition quality, image acquisition difficulty, and overall performance. Data are presented as means and percentages with standard deviation. All P values are based on 2-tailed tests of significance. RESULTS Total of 44 medical students participated in the study. All (100%) students completed the hands-on skills evaluation with a median score of 83.7% (IQR 76.7-88.4%). Thirty-three medical students completed all the online modules and quizzes with median score of 87.5% (IQR 83.8-91.3%). There was a positive association between module quiz performance and the hands-on skills performance (R-squared = 0.45; p < 0.001). There was no statistically significant association between module performance and hands-on performance for any of the four categories individually. In all four categories, the evaluators' observation of the medical students' difficulty obtaining views correlated with hands-on performance scores. CONCLUSIONS Our study findings suggest that ultrasound-naïve medical students can develop basic hands-on skills in image acquisition after reviewing online modules.
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Affiliation(s)
- Elaine Situ-LaCasse
- University of Arizona, College of Medicine & Banner University Medical Center - Tucson, Department of Emergency Medicine, PO Box 245057, Tucson, AZ 85724 USA
| | - Josie Acuña
- University of Arizona, College of Medicine & Banner University Medical Center - Tucson, Department of Emergency Medicine, PO Box 245057, Tucson, AZ 85724 USA
| | - Dang Huynh
- Tucson Medical Center, Department of Emergency Medicine, Tucson, AZ USA
| | - Richard Amini
- College of Medicine, Department of Emergency Medicine, University of Arizona, Tucson, AZ USA
| | | | - Kara Samsel
- Department of Emergency Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | | | - David E. Biffar
- Arizona Simulation Technology and Education Center – University of Arizona Health Sciences, Tucson, AZ USA
| | - Srikar Adhikari
- College of Medicine, Department of Emergency Medicine, University of Arizona, Tucson, AZ USA
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Lee A, Finstad A, Gawad N, Boet S, Raiche I, Balaa F. Nontechnical Skills (NTS) in the Undergraduate Surgical and Anesthesiology Curricula: Are We Adequately Preparing Medical Students? JOURNAL OF SURGICAL EDUCATION 2021; 78:502-511. [PMID: 32839149 DOI: 10.1016/j.jsurg.2020.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Nontechnical skills (NTS) encompass interpersonal, cognitive, and personal resource skills that can mitigate surgical errors and improve patient outcomes. However, inconsistencies in medical student awareness around NTS suggest limited exposure to these skills. This study aimed to determine the prevalence and content of NTS in medical school surgery and anesthesiology education. DESIGN AND SETTING Learning objectives from clerkship core surgery and anesthesiology rotations were collected from Canadian anglophone medical schools. Two raters independently classified each objective under one of the Non-Technical Skills for Surgeons (NOTSS) or Anaesthetists' Non-Technical Skills (ANTS) "Categories" and "Elements" of NTS, or as a non-NTS objective. Rater disagreements were resolved by group consensus. Group discussion was also held to identify examples of objectives that could help develop future curricula. Descriptive statistics were used to determine the number of NTS objectives from each school and within each NOTSS and ANTS Categories and Elements. RESULTS Learning objectives were obtained from 12 out of 14 Canadian medical schools. A total of 2116 surgery objectives and 571 anesthesiology objectives were reviewed. Of these, 16 (0.76%) and 26 (4.55%) were identified as NTS objectives in surgery and anesthesiology, respectively. Of the NOTSS and ANTS Categories, "Situation Awareness" and "Decision Making" were represented by only one objective each in both specialties. Approximately half of the NOTSS and ANTS Elements were not represented by a single objective. Group discussion yielded examples of NTS objectives that were excellent, could use improvement, or were too vague to be classified as NTS. CONCLUSIONS A paucity of objectives in the clerkship perioperative curricula involve NTS. These findings suggest that NTS are unlikely being adequately introduced as critical skillsets of surgeons and anesthesiologists in undergraduate perioperative education. Future curriculum development should involve greater medical student exposure to NTS as key components of their surgery and anesthesiology education.
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Affiliation(s)
- Alex Lee
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandra Finstad
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nada Gawad
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Innovation in Medical Education (DIME), University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Raiche
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fady Balaa
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Wheeler M, Powell E, Pallmann P. Use of High-fidelity simulation training for radiology healthcare professionals in the management of acute medical emergencies. Br J Radiol 2021; 94:20200520. [PMID: 33095674 DOI: 10.1259/bjr.20200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Life-threatening emergencies are relatively uncommon in the radiology department, but when encountered, require timely intervention. With an increasing number of critically unwell patients visiting the radiology department each year for both diagnostic and interventional procedures, it is vital that radiology staff are trained to provide basic resuscitation before further assistance arrives. Simulation training is a well-validated, effective method for rehearsing low-frequency, high-acuity events in a supportive and safe environment. The aim of our study was to investigate whether the introduction of a focussed, multidisciplinary simulation course would improve healthcare professional's knowledge and confidence when managing common medical emergencies; including cardiac arrest, anaphylaxis and airway obstruction. METHODS A multidisciplinary group of radiology staff attended a dedicated simulation teaching course. Participants completed a pre- and post-test questionnaire which assessed a range of knowledge domains and their perceived confidence with dealing with the clinical scenarios. The delegates were then asked to repeat this questionnaire 6 months after taking part in the course to assess their retention of skills and knowledge. RESULTS Knowledge scores increased by a mean difference of 4 points (p < 0.001). The mean pre- and post-course perceived confidence scores were 4.4/10 and 8/10, respectively. ADVANCES IN KNOWLEDGE This study suggests that embedding simulation training into the radiology curriculum improves healthcare professional's knowledge and perceived confidence when dealing with common medical emergencies. Although previous studies have looked at the use of simulation training for radiology trainees in the management of selected medical emergencies, to the authors' knowledge, this is the first study to demonstrate these benefits across a range of clinical scenarios, within an interprofessional environment.
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Affiliation(s)
- Matthew Wheeler
- Department of Radiology, University Hospital of Wales, Cardiff, Heath Park Way, Cardiff, UK
| | - Eleanor Powell
- Department of Anaesthetics, Intensive Care and Pain Medicine, University Hospital of Wales, Cardiff, Heath Park Way, Cardiff, UK
| | - Philip Pallmann
- Department of Biomedical & Life Sciences, Centre for Trials Research, Cardiff University, Cardiff, UK
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Bessmann EL, Rasmussen LS, Konge L, Kristensen MS, Rewers M, Kotinis A, Rosenstock CV, Graeser K, Pfeiffer P, Lauritsen T, Østergaard D. Anesthesiologists' airway management expertise: Identifying subjective and objective knowledge gaps. Acta Anaesthesiol Scand 2021; 65:58-67. [PMID: 32888194 DOI: 10.1111/aas.13696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Failure in airway management continues to cause preventable patient harm, and the recommended continuing education is challenged by anesthesiologists' unknown knowledge gaps. This study aimed to identify anesthesiologists' subjective and objective knowledge gaps as well as areas where anesthesiologists are incorrect and unaware. METHODS An adaptive E-learning program with 103 questions on adult airway management was used for subjective and objective assessment of anesthesiologists' knowledge. All anesthesiologists in the Capital Region of Denmark were invited to participate. RESULTS The response rate was 67% (191/285). For preoperative planning, participants stated low confidence (subjective assessment) regarding predictors of difficult airway management in particular (69.1%-79.1%). Test scores (objective assessment) were lowest for obstructive sleep apnea as a predictor of difficult airway management (28.8% correct), with participants being incorrect and unaware in 33.5% of the answers. For optimization of basic techniques, the lowest confidence ratings related to patient positioning and prediction of difficulties (57.4%-83.2%), which agreed with the lowest test scores. Concerning advanced techniques, videolaryngoscopy prompted the lowest confidence (72.4%-85.9%), while emergency cricothyrotomy resulted in the lowest test scores (47.4%-67.8%). Subjective and objective assessments correlated and lower confidence was associated with lower test scores: preoperative planning [r = -.58, P < .001], optimization of basic techniques [r = -.58, P = .002], and advanced techniques [r = -.71, P < .001]. CONCLUSION We identified knowledge gaps in important areas of adult airway management with differing findings from the subjective and objective assessments. This underlines the importance of objective assessment to guide continuing education.
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Affiliation(s)
- Ebbe L. Bessmann
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Michael S. Kristensen
- Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet Copenhagen Denmark
| | - Mikael Rewers
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
| | - Alexandros Kotinis
- Department of Anesthesia and Intensive Care, Brain and Nervous Diseases Rigshospitalet Glostrup Denmark
| | | | - Karin Graeser
- Department of Anaesthesia and Intensive Care Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | - Peter Pfeiffer
- Department of Anaesthesia Herlev and Gentofte Hospital Gentofte Denmark
| | - Torsten Lauritsen
- Department of Anaesthesia The Juliane Marie Center Rigshospitalet Copenhagen Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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E J SK, Purva M, Chander M S, Parameswari A. Impact of repeated simulation on learning curve characteristics of residents exposed to rare life threatening situations. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:351-355. [DOI: 10.1136/bmjstel-2019-000496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/03/2022]
Abstract
BackgroundLittle is known about the learning curve characteristics of residents undertaking simulation-based education. It is important to understand the time for acquisition and decay of knowledge and skills needed to manage rare and difficult clinical situations.MethodTen anaesthesiology residents underwent simulation-based education to manage a cannot intubate cannot ventilate scenario during general anaesthesia for caesarean section. Their performance was measured using an assessment tool and debriefed by two experienced anaesthesiologists. The parameters against which the performance was judged were grouped into preoperative assessment, preoperative patient care, equipment availability, induction sequence, communication and adherence to airway algorithm protocol. The scenario was repeated at 6 and 12 months thereafter. The residents’ acquisition of knowledge, technical and non-technical skills were assessed and compared at baseline, 6 months and end of 12 months.ResultThe skills of preoperative assessment, preoperative care and communication quickly improved but the specific skill of managing a difficult airway as measured by adherence to an airway algorithm required more than 6 months (CI at 6 vs 12 months: −3.4 to –0.81, p=0.016). The skills of preoperative assessment and preoperative care improved to a higher level quickly and were retained at this improved level. Communication (CI at 0 vs 6 months: −3.78 to −0.22, p=0.045 and at 6 vs 12 months : −3.39 to −1.49, p=0.007) and difficult airway management skill were slower to improve but continued to do so over the 12 months. The compliance to machine check was more gradual and showed an improvement at 12 months.ConclusionOur study is unique in analysing the learning curve characteristics of different components of a failed obstetric airway management skill. Repeated simulations over a longer period of time help in better reinforcement, retention of knowledge, recapitulation and implementation of technical and non-technical skills.
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Patel S, Wali A. Airway Management of the Obstetric Patient. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Smith C, McNarry AF. Airway Leads and Airway Response Teams: Improving Delivery of Safer Airway Management? CURRENT ANESTHESIOLOGY REPORTS 2020; 10:370-377. [PMID: 32837344 PMCID: PMC7369438 DOI: 10.1007/s40140-020-00404-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of Review Airway management remains a source of significant morbidity and mortality. This review considers recent summaries of complications and looks toward strategies to improve practice using a coordinated approach. Recent Findings A safety gap can exist between national recommendations and local practice. A lack of attention to end tidal carbon dioxide has repeatedly contributed to airway mismanagement. Clinicians must be trained in newer airway devices (videolaryngoscopes or supraglottic airways) to use them effectively. Time must be found to teach rarely performed skills (e.g., front-of-neck access). Both larger and smaller hospitals have benefitted from an airway lead or response team, coordinating education programs, ensuring the adoption of guidelines, standardizing equipment, and recognizing the role of human factors and ergonomics. Summary Even in the twenty-first century, the incidence of airway-related morbidity and mortality can be reduced, by an institutionally supported, coordinated approach to the whole process of airway care.
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Affiliation(s)
- Carolyn Smith
- South East Scotland School of Anaesthesia, St John’s Hospital, Livingston, EH54 6PP UK
| | - Alistair F. McNarry
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh, EH4 2XU UK
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Bessmann EL, Rasmussen LS, Konge L, Kristensen MS, Rewers M, Østergaard D, Kotinis A, Mitchell AU, Munksgaard ABF, Schousboe BMB, Rosenstock CV, Nielsen J, Frederiksen H, Graeser K, Larsen PB, Pfeiffer P, Lauritsen T. Maintaining competence in airway management. Acta Anaesthesiol Scand 2020; 64:751-758. [PMID: 32034955 DOI: 10.1111/aas.13558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Airway management is a defining skill for anaesthesiologists. Anaesthesiologists must maintain and update these crucial skills throughout their career, but how this is best achieved remains unclear. This study aimed to clarify anaesthesiologists' procedural volume, confidence in airway management and their current and preferred future educational strategies. METHODS A questionnaire was developed consisting of 28 items exploring essential skills in airway management. All anaesthesiologists in the Capital Region of Denmark were invited to participate. RESULTS The response rate was 84% (240/285). Most anaesthesiologists felt competent to a high or very high degree in basic airway management. Anaesthesiologists from anaesthesia felt confident to a significantly higher degree than those working in the intensive care unit (ICU) regarding the practical aspects of airway management in both the anticipated difficult airway (93% vs 73%, P < .001) and the unanticipated difficult airway (81% vs 61%, P = .002). Both groups performed most of the key advanced techniques ≤4 times yearly, whereas anaesthesiologists from the ICU had a lower and less diverse procedural volume than those working in anaesthesia. The anaesthesiologists preferred training through their daily clinical work, hands-on workshops, and scenario-based simulation training. However, a large discrepancy was identified between the current and the desired level of training. CONCLUSION The anaesthesiologists felt competent to a high or very high degree in basic airway management but the current procedural volume in advanced airway management causes concern for skill maintenance. Furthermore, we found a gap between the current and the desired level of supplemental training.
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Affiliation(s)
- Ebbe L. Bessmann
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Mikael Rewers
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Walsh BM, Wong AH, Ray JM, Frallicciardi A, Nowicki T, Medzon R, Bentley S, Stapleton S. Practice Makes Perfect. Emerg Med Clin North Am 2020; 38:363-382. [DOI: 10.1016/j.emc.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Thampi S, Lee CCM, Agrawal RV, Ashokka B, Ti LK, Paranjothy S, Ponnamperuma GG. Ideal Sequence of Didactic Lectures and Simulation in Teaching Transesophageal Echocardiography Among Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:1244-1249. [DOI: 10.1053/j.jvca.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
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Ritter KA, Horne C, Nassar A, French JC, Prabhu AS, Lipman JM. Multidisciplinary Simulation Training Improves Surgical Resident Comfort With Airway Management. J Surg Res 2020; 252:57-62. [PMID: 32234569 DOI: 10.1016/j.jss.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/27/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Airway management is an essential element of surgical training, but with fewer procedures performed during residency, simulation is crucial to fill educational gaps. We evaluated the effect of a multidisciplinary airway simulation on the comfort of general surgery residents in managing airways. MATERIALS AND METHODS All residents PGY 2-5 at a large academic general surgery residency program participated in a multidisciplinary airway management simulation. Precourse surveys evaluated self-perception of skills in three areas of airway management: surgical airway, basic ventilator strategies, and endotracheal intubation. Simulation consisted of didactic and procedural components and used high- and low-fidelity models including silicon airways, ventilators, porcine trachea, and airway adjuncts. Instruction was provided by anesthesia and otolaryngology faculty. Postcourse assessment was performed with a four-level Likert questionnaire. Results were analyzed using paired t-tests. RESULTS Of the 19 residents surveyed, 37% of residents had 1-5 h and 32% had 5-10 h of prior airway instruction. Significant increases in mean comfort were observed across all three studied areas. Residents reported increased comfort performing a surgical airway (1.16 versus 1.95), P < 0.0001, and troubleshooting ventilator issues (1.59 versus 2.16), P < 0.0001. Comfort regarding overall airway management including endotracheal intubation demonstrated similar improvement (1.84 versus 2.32), P = 0.02. Subgroup analysis by PGY level showed the greatest impact on comfort level in junior residents. CONCLUSIONS Multidisciplinary airway simulation can be effectively implemented in a general surgery training program and positively affect trainee comfort with these techniques, particularly among junior residents.
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Affiliation(s)
- Kaitlin A Ritter
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charlotte Horne
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed Nassar
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judith C French
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajita S Prabhu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Simulation Training for Critical Care Airway Management: Assessing Translation to Clinical Practice Using a Small Video-Recording Device. Chest 2020; 158:272-278. [PMID: 32113922 DOI: 10.1016/j.chest.2020.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/11/2020] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Critical care airway management (CCAM) is a key skill for critical care physicians. Simulation-based training (SBT) may be an effective modality in training intensivists in CCAM. RESEARCH QUESTION Is SBT of critical care fellows an effective means of providing training in CCAM, in particular in urgent endotracheal intubation? STUDY DESIGN AND METHODS Thirteen first-year pulmonary critical care medicine (PCCM) fellows at an academic training program underwent SBT with a computerized patient simulator (CPS) in their first month of fellowship training. At the end of the training period, the fellows underwent video-based scoring using a 46-item checklist (of which 40 points could be scored) while performing a complete CCAM sequence on the CPS. They were then tested, using video-based scoring on their first real-life CCAM. Maintenance of skill at CCAM was assessed during the fellows' second and third year of training, using the same scoring method. RESULTS For the first-year fellows, the score on the CPS was 38.3 ± 0.75 SD out of a maximum score of 40. The score on their first real-life patient CCAM was 39.0 ± 0.81 SD (P = .003 for equivalence; 95% CI for difference between real-life patient CCAM and CPS scores, 0.011-1.373). Sixteen second- and third-year fellows were tested at a real-life CCAM event later in their fellowship to examine for maintenance of skill. The mean maintenance of skill score of this group was 38.7 ± 1.14 SD. INTERPRETATION Skill acquired through SBT of critical care fellows for CCAM transfers effectively to the real-life patient care arena. Second- and third-year fellows who had initially received SBT maintained skill at CCAM.
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