1
|
Abrams J, Mahoney B. The importance of simulation-based multi professional training in obstetric anesthesia: an update. Curr Opin Anaesthesiol 2024; 37:239-244. [PMID: 38390920 DOI: 10.1097/aco.0000000000001352] [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: 02/24/2024]
Abstract
PURPOSE OF REVIEW Simulation-based training remains an integral component of medical education by providing a well tolerated, controlled, and replicable environment for healthcare professionals to enhance their skills and improve patient outcomes. Simulation technology applied to obstetric anesthesiology continues to evolve as a valuable tool for the training and assessment of the multidisciplinary obstetric care team. RECENT FINDINGS Simulation-based technology has continued to play a role in training and assessment, including recent work on interdisciplinary communication, recognition, and management of obstetric hemorrhage, and support in the low or strained resource setting. The COVID-19 pandemic has accelerated the evolution of simulation-based training away from a reliance on in-situ or high-fidelity manikin-based approaches toward an increasing utilization of modalities that allow for remote or asynchronous training. SUMMARY The evolution of simulation for interdisciplinary training and assessment in obstetric anesthesia has accelerated, playing a greater role in aspects of communication, management of hemorrhage and supporting low or strained resource settings. Augmented reality, virtual reality and mixed reality have advanced dramatically, spurred on by the need for remote and asynchronous simulation-based training during the pandemic.
Collapse
Affiliation(s)
- Jordan Abrams
- Mount Sinai Morningside and West Hospitals, New York, New York, USA
| | | |
Collapse
|
2
|
Mahoney B, Luebbert E. Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic. Anesthesiol Clin 2021; 39:649-665. [PMID: 34776102 PMCID: PMC8584716 DOI: 10.1016/j.anclin.2021.08.001] [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: 01/04/2023]
Abstract
Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of simulation technology. Prior reviews of this topic have focused on simulation for individual and team training and assessment. The COVID-19 pandemic has provided an opportunity for educators and leaders in obstetric anesthesiology to rapidly train health care providers and develop new protocols for patient care with simulation. This review surveys new developments in simulation for obstetric anesthesiology with an emphasis on simulation use during the COVID-19 pandemic.
Collapse
|
3
|
Sotto KT, Hedli LC, Sie L, Padua K, Yamada N, Lee H, Halamek L, Daniels K, Nathan-Roberts D, Austin NS. Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery. PLoS One 2021; 16:e0252888. [PMID: 34111177 PMCID: PMC8191948 DOI: 10.1371/journal.pone.0252888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
Cesarean delivery is the most common surgery performed in the United States, accounting for approximately 32% of all births. Emergency Cesarean deliveries are performed in the event of critical maternal or fetal distress and require effective collaboration and coordination of care by a multidisciplinary team with a high level of technical expertise. It is not well understood how the physical environment of the operating room (OR) impacts performance and how specialties work together in the space.
Collapse
Affiliation(s)
- Kenji T. Sotto
- San José State University, San Jose, California, United States of America
- * E-mail: (KTS); (DNR)
| | - Laura C. Hedli
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Lillian Sie
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Kimber Padua
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Nicole Yamada
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Henry Lee
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Louis Halamek
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Kay Daniels
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, United States of America
| | - Dan Nathan-Roberts
- San José State University, San Jose, California, United States of America
- * E-mail: (KTS); (DNR)
| | - Naola S. Austin
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, United States of America
| |
Collapse
|
4
|
General anesthesia for emergency cesarean delivery: simulation-based evaluation of residents. Braz J Anesthesiol 2021; 71:254-258. [PMID: 33940059 PMCID: PMC9373071 DOI: 10.1016/j.bjane.2021.02.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Decreased rates of General Anesthesia (GA) for Cesarean Section (C-section) create a learning problem for anesthesia trainees. In this context, training the management of GA for C-section using simulation techniques allows a safe environment for exposure, learning, performance improvement, and capability retention. Objective Analyze anesthesia residents’ performance regarding a simulated clinical case of GA for emergency C-section and identify specific deficits in skill acquisition. Methods Between 2015 and 2018, we evaluated the performance of 25 anesthesiology residents challenged by a simulated clinical case of GA for emergency C-section after the conclusion of the obstetric anesthesia rotation. Each resident performed the clinical case once followed by the assessment of their performance. Final scores were given according to the completion rate of 14-tasks, going from 0% to 100%. Two study groups were considered according to residency year for subsequent comparison of results (Group 1, second and third residency years and Group 2, fourth and fifth residency years). Results and discussion Mean score was 64.29% ± 13.62. Comparatively, Group 1 obtained a higher score than Group 2 (70.63% ± 14.02 vs. 60.27% ± 11.94), although with no statistically significant difference (p = 0.063). The tasks most frequently accomplished were opioid administration (100%), rapid sequence technique (100%), pre-oxygenation (92%), gastric content aspiration prophylaxis (84%), and previous clinical history (84%). Conversely, the tasks less frequently accomplished were confirming presence of pediatrician (64%), oxytocin administration (56%), PONV prophylaxis (56%), and preoperative airway assessment (48%). Conclusion The performance of the residents observed in this study was comparable to results previously published. The final score did not depend on the residency year.
Collapse
|
5
|
Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:18-27. [PMID: 33642943 PMCID: PMC7902754 DOI: 10.1007/s40140-021-00437-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
Purpose of the Review The use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this review, we will discuss clinical scenarios and risk factors associated with general anesthesia for cesarean delivery and address reasons why anesthesiologists should apply strategies to minimize its use. Recent Findings Unnecessary general anesthesia for cesarean delivery is associated with maternal complications, including serious anesthesia-related complications, surgical site infection, and venous thromboembolic events. Racial and socioeconomic disparities and low-resource settings are major contributing factors in the use of general anesthesia for cesarean delivery, with both maternal and perinatal mortality increasing when general anesthesia is provided. In addition, more significant maternal pain and higher rates of postpartum depression requiring hospitalization are associated with general anesthesia for cesarean delivery. Summary Rates of general anesthesia for cesarean delivery have overall decreased, and while general anesthesia no longer is a contributing factor to anesthesia-related maternal deaths, further opportunities to reduce its use should be emphasized. Raising awareness in identifying situations and patients at risk to help avoid unnecessary general anesthesia remains crucial.
Collapse
Affiliation(s)
- Laurence Ring
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA USA
| |
Collapse
|
6
|
Bican R, Heathcock JC, Jedryszek F, Debarge V, DeJonckheere J, Cybalski MC, Hanssens S. Job role and stress influence student movement during postpartum haemorrhage simulation: an exploratory study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:323-328. [DOI: 10.1136/bmjstel-2020-000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022]
Abstract
IntroductionPostpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement.MethodsN=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement.ResultsMidwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10).ConclusionsPhysical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia. RECENT FINDINGS Simulation training is becoming more integrated in the modern education of anesthesiologists. Research regarding the most effective way to perform simulation training in terms of learning outcomes and long-term skill retention has started to appear. Scenarios which are played independently and that allow for simulated mortality, as well as relaxation techniques before debriefing might have positive effects in this regard. Furthermore, simulation has been investigated as a tool to improve patient safety in low-resource settings. In addition, simulation training in the domain of obstetrics has been rapidly expanding and has an important role in this field of medicine as well. SUMMARY Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.
Collapse
|
8
|
Benefits of Screen-Based Postpartum Hemorrhage Simulation on Nontechnical Skills Training: A Randomized Simulation Study. Simul Healthc 2020; 14:391-397. [PMID: 31804424 DOI: 10.1097/sih.0000000000000395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Nontechnical skills (NTS), such as communication and teamwork, are critical for efficient management of this obstetric emergency. Specific scenarios were designed on a screen-based simulator to train NTS. This study aimed to evaluate the impact of training midwives for NTS with a PPH screen-based simulation. METHODS A total of 24 midwives participated in the study. They were randomized in 2 groups: the NTS group (n = 12) performed 3 screen-based scenarios designed to train NTS and the control group (n = 12) performed 3 basic scenarios of the screen-based simulation without the NTS training. A structured interview followed the simulation. On the same day, each trainee underwent individually an evaluation on a PPH high-fidelity simulation scenario. Three experts, blinded to the study arm, assessed the NTS with the Anesthetists Non-Technical Skills (ANTS) score. RESULTS Midwives from the NTS group achieved higher median scores in each dimension of the ANTS score: task management (4 vs. 2/4, P < 0.0001), team working (4 vs. 2/4, P < 0.0001), situation awareness (4 vs. 2.7/4, P < 0.0001), and decision-making (4 vs. 2/4, P < 0.0001). The median value of the total ANTS score was higher in the NTS group than in the control group (15.5 vs. 8/16, P < 0.0001). CONCLUSIONS Our study highlights that training with a NTS screen-based simulation, with specific scenarios and debriefing, leads to higher midwives' nontechnical skills performance during simulated postpartum hemorrhage.
Collapse
|
9
|
Chan JJ, Goy RW, Ithnin F, Sng BL. Difficult obstetric airway training: Current strategies, challenges and future innovations. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|