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Babus LW, Gurnaney H, Doshi AK, Liu H, Nishisaki A, Singh D, Daly Guris RJ. The utility of virtual reality and manikin crisis scenario simulations for anaesthesia trainee education: a randomised crossover pilot study. Anaesth Rep 2024; 12:e12316. [PMID: 39100911 PMCID: PMC11292116 DOI: 10.1002/anr3.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/06/2024] Open
Abstract
Simulation education for anaesthesia trainees is essential to build clinical skills and virtual reality can provide a reproducible, high-fidelity intra-operative training environment. Compared to in-situ manikin-based simulation, this modality has yet to be thoroughly evaluated. Twenty-six second post-graduate year anaesthesiology residents were randomly divided into two groups and participated in both virtual reality and manikin crisis scenarios at sessions six months apart. The exposure order was group A virtual reality followed by manikin and group B manikin followed by virtual reality. Clinical assessments were performed using a standardised checklist. Knowledge assessments were conducted. National Aeronautics and Space Administration Task Load Index and System Usability Scale scores were collected immediately after participation. Clinical scores between groups A and B were not significantly different. Group A had improved post-simulation knowledge scores after both sessions. Task load index scores were lower in mental demand for virtual reality. System usability scores showed less ease of use and more need for support in virtual reality.
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Affiliation(s)
- L. W. Babus
- Department of Anaesthesia and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - H. Gurnaney
- Department of Anaesthesia and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - A. K. Doshi
- Department of Anaesthesia and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - H. Liu
- Department of Biomedical and Health InformaticsResearch Institute, Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - A. Nishisaki
- Department of Anaesthesia and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Center for Simulation, Advanced Education and InnovationChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - D. Singh
- Department of Anaesthesia and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - R. J. Daly Guris
- Department of Anaesthesia and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Center for Simulation, Advanced Education and InnovationChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
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Daly Guris RJ, George P, Gurnaney HG. Simulation in pediatric anesthesiology: current state and visions for the future. Curr Opin Anaesthesiol 2024; 37:266-270. [PMID: 38573191 DOI: 10.1097/aco.0000000000001375] [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: 04/05/2024]
Abstract
PURPOSE OF REVIEW Simulation is a well established practice in medicine. This review reflects upon the role of simulation in pediatric anesthesiology in three parts: training anesthesiologists to care for pediatric patients safely and effectively; evaluating and improving systems of care for children; and visions for the future. RECENT FINDINGS Simulation continues to prove a useful modality to educate both novice and experienced clinicians in the perioperative care of infants and children. It is also a powerful tool to help analyze and improve upon how care is provided to infants and children. Advances in technology and computational power now allow for a greater than ever degree of innovation, accessibility, and focused reflection and debriefing, with an exciting outlook for promising advances in the near future. SUMMARY Simulation plays a key role in developing and achieving peak performance in the perioperative care of infants and children. Although simulation already has a great impact, its full potential is yet to be harnessed.
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Affiliation(s)
- Rodrigo J Daly Guris
- Children's Hospital of Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia
| | - Preeta George
- Division of Pediatric Anesthesiology, Department of Anesthesiology, St. Louis Children's Hospital, Washington University, Missouri, USA
| | - Harshad G Gurnaney
- Children's Hospital of Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia
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3
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Bas Ikizoglu N, Atag E, Ergenekon P, Gokdemir Y, Uyan ZS, Girit S, Kilinc Sakalli AA, Erdem Eralp E, Cakir E, Guven F, Aksoy ME, Karadag B, Karakoc F, Oktem S. Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team. Front Pediatr 2024; 12:1325582. [PMID: 38362002 PMCID: PMC10867101 DOI: 10.3389/fped.2024.1325582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. Methods A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Results Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. Conclusion The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.
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Affiliation(s)
- Nilay Bas Ikizoglu
- Division of Pediatric Pulmonology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Emine Atag
- Division of Pediatric Pulmonology, School of Medicine, Maltepe University, Istanbul, Turkiye
| | - Pinar Ergenekon
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, School of Medicine, Koc University, Istanbul, Turkiye
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkiye
| | - Ayse Ayzit Kilinc Sakalli
- Division of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul-Cerrahpasa University, Istanbul, Turkiye
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Istinye University, Istanbul, Turkiye
| | - Feray Guven
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Bulent Karadag
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Sedat Oktem
- Division of Pediatric Pulmonology, School of Medicine, Medipol University, Istanbul, Turkiye
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Ambardekar AP, Eriksen W, Ferschl MB, McNaull PP, Cohen IT, Greeley WJ, Lockman JL. A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study. Anesth Analg 2023; 136:437-445. [PMID: 35777829 DOI: 10.1213/ane.0000000000006128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric anesthesiology fellowship education has necessarily evolved since Accreditation Council for Graduate Medical Education (ACGME) accreditation in 1997. Advancements in perioperative and surgical practices, emerging roles in leadership, increasing mandates by accreditation and certification bodies, and progression toward competency-based education-among other things-have created pressure to enrich the current pediatric anesthesiology training system. The Society for Pediatric Anesthesia (SPA) formed a Task Force for Pediatric Anesthesiology Graduate Medical Education that included key leaders and subject matter experts from the society. A key element of the Task Force's charge was to identify curricular and evaluative enhancements for the fellowship program of the future. METHODS The Task Force executed a nationally representative, stakeholder-based Delphi process centered around a fundamental theme: "What makes a pediatric anesthesiologist?" to build consensus among a demographically varied and broad group of anesthesiologists within the pediatric anesthesiology community. A total of 37 demographically and geographically varied pediatric anesthesiologists participated in iterative rounds of open- and close-ended survey work between August 2020 and July 2021 to build consensus on the current state, known deficiencies, anticipated needs, and strategies for enhancing national educational offerings and program requirements. RESULTS Participation was robust, and consensus was almost completely achieved by round 2. This work generated a compelling Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis that suggests more strengths and opportunities in the current Pediatric Anesthesiology Graduate Medical Education program than weaknesses or threats. Stakeholders agreed that while fellows matriculate with some clinical knowledge and procedural gaps, a few clinical gaps exist upon graduation. Stakeholders agreed on 8 nonclinical domains and specific fundamental and foundational knowledge or skills that should be taught to all pediatric anesthesiology fellows regardless of career plans. These domains include (1) patient safety, (2) quality improvement, (3) communication skills, (4) supervision skills, (5) leadership, (6) medical education, (7) research basics, and (8) practice management. They also agreed that a new case log system should be created to better reflect modern pediatric anesthesia practice. Stakeholders further identified the need for the development of standardized and validated formative and summative assessment tools as part of a competency-based system. Finally, stakeholders noted that significant departmental, institutional, and national organizational support will be necessary to implement the specific recommendations. CONCLUSIONS A Delphi process achieved robust consensus in assessing current training and recommending future directions for pediatric anesthesiology graduate medical education.
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Affiliation(s)
- Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Whitney Eriksen
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marla B Ferschl
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Peggy P McNaull
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Ira T Cohen
- Division of Anesthesiology and Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's National, Washington, DC
| | - William J Greeley
- Departments of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Salaün JP, De Queiroz M, Chagnot A, Veyckemans F, Orliaguet G. A nationwide survey of paediatric anaesthesia and intensive care training in France. Anaesth Crit Care Pain Med 2022; 41:101117. [DOI: 10.1016/j.accpm.2022.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
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Munshey F, McDonnell C, Matava C. Pediatric anesthesia training to early career stage: Opportunities for firm foundations. Paediatr Anaesth 2021; 31:24-30. [PMID: 32726879 DOI: 10.1111/pan.13978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022]
Abstract
Attaining professional contentment can be challenging for many. Academic success, psychosocial support, and the confidence to provide excellent clinical care at the workplace are key pillars that can help build a sense of meaning in a career. The role of mentorship in facilitating these key pillars at different stages of pediatric anesthesia training and new independent practice is instrumental. For mentees aspiring for a career in pediatric anesthesia, there are several points of focus. Mentees should seek out mentors early in training, build on these relationships, and explore opportunities for peer mentorship as they advance in their career. For mentors, introducing mentees to the clinical and academic aspects of pediatric anesthesia and setting the foundation for the mentee to advance in their career can be both gratifying and stimulating. In this article, we explore the development and progression of a mentor-mentee relationship through training to the early career stage and its role in developing a meaningful career in pediatric anesthesia.
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Affiliation(s)
- Farrukh Munshey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Conor McDonnell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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7
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Obara S, Kuratani N. Training in pediatric anesthesia in Japan: how should we come along? J Anesth 2020; 35:471-474. [PMID: 33009926 DOI: 10.1007/s00540-020-02859-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Soichiro Obara
- Department of Anesthesia, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1, Minami-ohtsuka, Toshima-ku, Tokyo, 170-8476, Japan.
- Teikyo University Graduate School of Public Health, Tokyo, Japan.
| | - Norifumi Kuratani
- Teikyo University Graduate School of Public Health, Tokyo, Japan
- Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
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Ambardekar AP, Newell A, Blassius K, Waldrop WB, Young DA. Medical simulation utilization among pediatric anesthesiology fellowship programs. Paediatr Anaesth 2020; 30:823-832. [PMID: 32335993 DOI: 10.1111/pan.13895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Simulation-based education is a mainstay in education of pediatric anesthesiology trainees. Despite the known benefits, there is variability in its use and availability among various pediatric anesthesiology fellowship programs. AIM The primary aim was to understand the current state of simulation-based education among pediatric anesthesiology fellowship programs and define barriers that impede the development of an effective simulation program. METHODS This survey-based, observational study of simulation activities within United States-based pediatric anesthesiology fellowship programs was approved by the Institutional Review Boards (IRB) of the authors' institutions. A 35-question survey was developed in an iterative manner by simulation educators (AA, WW, DY) and a statistician familiar with survey-based research (AN) using research electronic data capture (REDCap) for tool development and data collation. Descriptive and thematic analyses were performed on the quantitative and qualitative responses in the survey, respectively, and were stratified with small, medium, and large fellowship programs. RESULTS Forty-five of 60 (75%) fellowship programs responded to the survey. The presence of a dedicated simulation program director and number of simulation instructors was positively associated with the size of program and years in operation. Dedicated simulation support was variable across programs and was usually present within the larger programs. A positive association also existed for educational activities among all programs mostly based on size of program and years in operation. Protected time was the most commonly cited barrier to having a comprehensive and sustainable simulation program. There was general agreement for establishing a standardized and shared curriculum among fellowship programs. Approximately 70% of simulation programs had no formal simulation instructor training requirement. CONCLUSIONS Simulation-based curricula are broadly offered by many fellowship programs. Improved collaboration locally, regionally, and nationally may improve educational opportunities for fellowship programs, particularly the small ones. These efforts may begin with the development of a standardized curriculum and formal instructor training programs.
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Affiliation(s)
- Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Alana Newell
- Center for Educational Outreach, Baylor College of Medicine, Houston, TX, USA
| | - Kim Blassius
- Scope Anesthesia of North Carolina, Raleigh, NC, USA
| | - William B Waldrop
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - David A Young
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Marraro GA. Selective bronchial intubation for one-lung ventilation and independent-lung ventilation in pediatric age: state of the art. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020. [PMID: 32571450 DOI: 10.7499/j.issn.1008-8830.1912121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Selective bronchial intubation (SBI) to ventilate a single lung (one-lung ventilation, OLV) or to apply separate lung ventilation (independent-lung ventilation, ILV) can be frequently required under general anesthesia in pediatrics, mainly in video assisted thoracoscopy surgery, in the postoperative care of cardio-thoracic surgery, and for the treatment of lung pathologies with unilateral prevalence in intensive care. In children over 6-8 years of age SBI, OLV and ILV can be performed using marketed double-lumen tubes (DLTs). In neonates, infants and younger children the application of ILV is limited due to the lack of DLTs. For children of this age, a specific DLT for ILV was developed (Marraro Paediatric Endobronchial Bilumen Tube®) but is currently available only as a special product. The DLT represents the device of choice for OLV and ILV while the use of bronchial blocker is suggested as an alternative to achieve the SBI and the OLV when suitable DLTs are not available. Different catheters types can be used as bronchial blocker. If SBI is not possible using DLT or bronchial blocker, a conventional single-lumen tube of adequate length can allow SBI in all pediatric ages. Using the bronchial blocker and single lumen tube it is possible to perform OLV but it is impossible to apply ILV. The main complications of SBI and DLT are largely due to limited operator experience. Airway trauma, dislodgment and obstruction of the devices are quite frequent and can lead to severe hypoxia if not recognized and treated early.
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McKelvie BL, Lobos AT, Chan J, Momoli F, McNally JD. High Rate of Medical Emergency Team Activation in Children with Tracheostomy. J Pediatr Intensive Care 2019; 9:27-33. [PMID: 31984154 DOI: 10.1055/s-0039-1695733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022] Open
Abstract
Pediatric in-patients with tracheostomy (PIT) are at high risk for clinical deterioration. Medical emergency teams (MET) have been developed to identify high-risk patients. This study compared MET activation rates between PITs and the general ward population. This was a retrospective cohort study conducted at a tertiary pediatric hospital. The primary outcome (MET activation) was obtained from a database. Between 2008 and 2014, the MET activation rate was significantly higher in the PIT group than the general ward population (14 vs. 2.9 per 100 admissions, p < 0.001). PITs are at significantly higher risk for MET activation. Strategies should be developed to reduce their risk on the wards.
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Affiliation(s)
- Brianna L McKelvie
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, Western University, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
| | - Anna-Theresa Lobos
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jason Chan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - James Dayre McNally
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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