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Keeyapaj W, Cheung AT. Evaluation of the Efficacy of a Novel Dermatotomy Device for Central Venous Cannulation. J Cardiothorac Vasc Anesth 2024; 38:1951-1956. [PMID: 38908939 DOI: 10.1053/j.jvca.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To test the effectiveness of a novel wire-guided scalpel (Guideblade) to create a precise dermatotomy incision for central venous catheter (CVC) insertion. DESIGN Prospective, nonrandomized interventional study. SETTING Stanford University, single-center teaching hospital. PARTICIPANTS Cardiac and vascular surgical patients (n = 100) with planned CVC insertion for operation. INTERVENTIONS A wire-guided scalpel was used during CVC insertion. RESULTS A total of 188 CVCs were performed successfully with a wire-guided scalpel without the need for additional equipment in 100 patients, and 94% of CVCs were accomplished with only a single dermatotomy attempt. "No bleeding" or "minimal bleeding" at the insertion site was observed in 90% of patients 30 minutes after insertion and 80.7% at the conclusion of surgery. CONCLUSION The wire-guided scalpel was effective in performing dermatotomy for CVC with a 100% success rate and a very high first-attempt rate. The wire-guided scalpel may decrease bleeding at the CVC insertion site.
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Affiliation(s)
- Worasak Keeyapaj
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305.
| | - Albert T Cheung
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305
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McCaffrey RL, Cassling K, Davidson M, Kauffmann R, Shelton J, Bailey CE, Terhune K. Comparing Faculty and Trainee Evaluators of First-Year Resident Skills. JOURNAL OF SURGICAL EDUCATION 2024; 81:219-225. [PMID: 38172040 DOI: 10.1016/j.jsurg.2023.10.015] [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: 03/16/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To determine if senior residents are comparable to faculty in assessing first-year resident skills on their overall assessment. BACKGROUND As resident training moves towards a competency-based model, innovative approaches to evaluation and feedback through simulation need to be developed for both procedural as well as interpersonal and communication skills. In most areas of simulation, the faculty assess resident performance however; in clinical practice, first-year residents are often overseen and taught by senior residents. We aim to explore the agreement between faculty and senior resident assessors to determine if senior residents can be incorporated into a competency-based curriculum as appropriate evaluators of first-year resident skills. DESIGN Annual surgical first year resident training for central line placement, obtaining informed consent and breaking bad news at a single institution is assessed through an overall assessment (OA). In previous years, only faculty have been the evaluators for the OA. In this study, select senior residents were asked to participate as evaluators and agreement between groups of evaluators was assessed across the 3 tasks taught during surgical first-year resident training. SETTING Vanderbilt University Medical Center, tertiary hospital, Simulation Center. PARTICIPANTS Anesthesia and surgery interns, chief residents, anesthesia and surgical faculty. RESULTS Agreement between faculty and senior resident assessors was strongest for the central line placement simulation with a faculty average competency score of 10.71 and 9.59 from senior residents (κ = 0.43; 95% CI: -0.2, 0.34). Agreement was less substantial for simulated informed consent (κ = 0.08; 95% CI: -0.19, 0.36) and the breaking bad news simulation (κ = 0.07; 95% CI: -0.2, 0.34). CONCLUSION Select senior residents are comparable to faculty evaluators for procedural competency; however, there was less agreement between evaluator groups for interpersonal and communication-based competencies.
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Affiliation(s)
- Rachel L McCaffrey
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Kyle Cassling
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mario Davidson
- Department of Bioinformatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Rondi Kauffmann
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia Shelton
- Department of Surgery, University of Iowa School of Medicine, Iowa City, Iowa
| | - Christina E Bailey
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyla Terhune
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Tanwani J, Nabecker S, Hiansen JQ, Mashari A, Siddiqui N, Arzola C, Goffi A, Peacock S. Use of a Novel Three-Dimensional Model to Teach Ultrasound-guided Subclavian Vein Cannulation. ATS Sch 2023; 4:344-353. [PMID: 37795109 PMCID: PMC10547090 DOI: 10.34197/ats-scholar.2022-0104in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/18/2023] [Indexed: 10/06/2023] Open
Abstract
Background Central venous cannulation is an essential skill in perioperative and critical care medicine. Ultrasound guidance is the standard of care for femoral and internal jugular vein access, with the subclavian vein being perceived to be less amenable to ultrasound-guided (UG) insertion, resulting in a lack of procedural competency and low cannulation rate. There is a paucity of resources and a lack of experience among staff physicians to effectively instruct trainees. Simulation-based medical education has the potential to help maintain high-stakes, infrequently performed skills and counteract possible unrecognized skill decline. We aimed to create a novel, low-cost, high-fidelity three-dimensional (3D) model for UG subclavian vein (UG-SCV) access with an accompanying curriculum to improve this important skill. Methods A curriculum was created consisting of preparatory material reviewing UG-SCV access, followed by an in-person didactic lecture focusing on ultrasound use and management of complications and a deliberate practice session scanning volunteers and practicing UG vascular puncture on a 3D model. A qualitative usability test design was used to assess the validity of the curriculum in trainees with advanced vascular access skills (anesthesiologists). Participants were second-year anesthesia residents, anesthesia fellows, and staff physicians. Focus groups conducted after each session explored the face validity of the model and curriculum. By applying a usability design, the curriculum was optimized and finalized. Results Between September 2020 and February 2021, 28 participants tested the curriculum. The focus groups ensured that the curriculum achieved its objective, with iterative changes made after each session in a quality improvement framework Plan-Do-Study-Act approach. After the third cycle, minimal changes were suggested, and the curriculum and 3D model were finalized. An additional group of participants was used to ensure that no new input would help improve the curriculum further. Conclusions A focused curriculum for enhancing skills in UG-SCV cannulation using a novel 3D model was successfully implemented and validated through a usability test design. This curriculum is better targeted for practitioners experienced in central venous access to master a subclavian approach and maintain their skill level.
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Affiliation(s)
- Jaya Tanwani
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Joshua Qua Hiansen
- Department of Anesthesia and Pain
Management, and
- Advanced Perioperative Imaging Lab,
Toronto General Hospital, Toronto, Ontario, Canada
| | - Azad Mashari
- Department of Anesthesia and Pain
Management, and
- Advanced Perioperative Imaging Lab,
Toronto General Hospital, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Cristian Arzola
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Alberto Goffi
- Keenan Research Centre and Li Ka Shing
Knowledge Institute, Department of Critical Care Medicine, St. Michael’s
Hospital, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical
Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Peacock
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
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4
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Piquette D, Spring J. Gender Disparity in Procedural Training: A Persistent Problem in Need of Early Interventions. ATS Sch 2023; 4:109-112. [PMID: 37538070 PMCID: PMC10394592 DOI: 10.34197/ats-scholar.2023-0041ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Dominique Piquette
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada; and
| | - Jenna Spring
- University of Toronto, Toronto, Ontario, Canada; and
- Mount Sinai Hospital, Toronto, Ontario, Canada
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Khoujah D, Naples JG, Silva LOJE, Edlow JA, Gerberi DJ, Carpenter CR, Bellolio F. Epley maneuver for benign paroxysmal positional vertigo: Evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med 2023. [PMID: 37186435 DOI: 10.1111/acem.14739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Canalith repositioning maneuvers (such as the Epley maneuver) are recommended by specialty guidelines for management of benign paroxysmal positional vertigo (BPPV) yet are frequently underutilized in the emergency department (ED). METHODS We conducted a systematic review of systematic reviews to summarize the evidence of Epley maneuver for the treatment of posterior canal (pc) BPPV in any setting. We included systematic reviews of randomized controlled trials (RCTs) that compared Epley to control in adult patients with pc-BPPV. Titles, abstracts, and full texts were screened in duplicate. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Meta-analysis of individual studies was conducted with random and fixed effects. RESULTS From 2,228 titles, 7 systematic reviews were selected for quality assessment. One review was of higher methodological quality, included only RCTs, and was the most current and comprehensive. Five of the 11 RCTs of the review, including 312 patients with pc-BPPV diagnosed by Dix-Hallpike, were relevant to our question. Meta-analysis of 4 RCTs (251 patients) showed the use of Epley (as compared to control) was associated with higher complete resolution of vertigo at 1 week (OR 7.19, CI 1.52 to 33.98, moderate certainty). Meta-analysis of 3 RCTs (195 patients) showed the use of Epley was associated with higher conversion to negative Dix-Hallpike at 1 week (OR 6.67, CI 1.52 to 33.98, moderate certainty). The number-needed-to-treat was 3. Meta-analysis of the outcomes at 1 month, and when observational studies were included, showed similar results. No serious adverse effects were reported. CONCLUSIONS Symptoms of pc-BPPV improve with the Epley maneuver. Emergency clinicians should become familiar with performing the Epley for BPPV. Further studies on ED implementation and clinician education of Epley are needed.
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Affiliation(s)
- Danya Khoujah
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Emergency Medicine, AdventHealth Tampa, Tampa, Florida, USA
| | - James G Naples
- Center, Division of Otolaryngology-Head & Neck Surgery, Beth, Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucas Oliveira J E Silva
- Department of Emergency Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University at St. Louis, St. Louis, Missouri, USA
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
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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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Parikh T, Al-Bassam W, Shehabi Y, Pakavakis A, Subramaniam A. Current practice, education, and recommendations for training of central line insertion for trainees and fellows in adult ICUs across Australia and New Zealand. Intern Med J 2022; 53:723-730. [PMID: 35014135 DOI: 10.1111/imj.15692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to explore variability in existing training and accreditation processes for Central venous access device (CVAD) insertion among different ICUs, current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement. METHODS A prospective cross-sectional web-based survey was sent via email and CICM e-Newsletter to intensivists and directors of intensive care units (ICUs) across ANZ. All responses were tabulated, post-hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarized. RESULTS 115 responses were received from various public and private ICUs from all states of ANZ. 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICUs, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools, and ultrasound training to improve training and assessment. 35% of the participants inserted 0 to 5 CVADs and more than half of the intensivists had inserted <10 CVADs in one-year period. Two-thirds of the respondents recommended inserting between 6 to 20 CVADs each year to maintain competence. CONCLUSION The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion amongst intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICUs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tapan Parikh
- Department of Intensive care, Monash Medical Centre, Frankston, Victoria, Australia
| | - Wisam Al-Bassam
- Department of Intensive care, Monash Medical Centre, Frankston, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Yahya Shehabi
- Department of Intensive care, Monash Medical Centre, Frankston, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Adrian Pakavakis
- Department of Intensive care, Monash Medical Centre, Frankston, Victoria, Australia.,Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Sattler LA, Schuety C, Nau M, Foster DV, Hunninghake J, Sjulin T, Boster J. Simulation-Based Medical Education Improves Procedural Confidence in Core Invasive Procedures for Military Internal Medicine Residents. Cureus 2020; 12:e11998. [PMID: 33437553 PMCID: PMC7793434 DOI: 10.7759/cureus.11998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction The American Board of Internal Medicine (ABIM) requires that trainees receive procedural training for certification; however, Internal Medicine (IM) residents perform a variable number of procedures throughout residency training. This results in differences in confidence levels as well as procedural competence. For active-duty military trainees, this is especially problematic, as these procedural skills are often required during deployment soon after residency graduation. This deficit can be improved through standardized simulation-based training. Methods All internal medicine residents at our institution were invited to participate in a standardized simulation-based training program for core internal medicine procedures (lumbar puncture, arterial line, central line, thoracentesis, paracentesis, and arthrocentesis). Residents were asked to qualitatively rate their perceived procedural confidence using a Likert scale ranging from 1 (not at all confident) to 5 (extremely confident) in their ability to independently perform core internal medicine procedures prior to the simulation exercise. Experienced senior residents and internal medicine faculty instructed and supervised each resident as they performed the procedures. Following the simulation exercise, the residents repeated the survey and were asked to report whether or not they found the exercise useful. Results Of the 96 residents invited to participate, 49 completed the pre-simulation questionnaire and 36 completed the post-simulation questionnaire. The cumulative mean Likert scale confidence rating for all procedures showed a statistically significant improvement post-simulation as compared to pre-simulation, including lumbar puncture (2.45±1.1 vs. 3.42±0.87, p<0.05), arterial line (2.48±1.06 vs. 3.39±1.04, p < 0.05), central line (2.86±1.08 vs. 3.5±1.02, p < 0.05), thoracentesis (2.67±1.10 vs. 3.64±0.83, p < 0.05), paracentesis (3.1±1.08 vs. 3.82±0.74, p < 0.05), and arthrocentesis (2.56±1.07 vs. 3.67±0.80, p < 0.05). All (36/36) trainees reported that they perceived the simulation exercise as valuable. Conclusion Internal medicine residents across all post-graduate year (PGY) levels at our institution lacked confidence to independently perform core internal medicine procedures. Utilizing simulation-based medical education as an adjunct to clinical training is well accepted by internal medicine trainees, and resulted in significantly improved procedural confidence. This intervention was well received by trainees and could feasibly be replicated at other active-duty military internal medicine residency programs to assist with readiness. Research is currently in progress to correlate in-situ competency and evaluate clinical outcomes of this improved confidence.
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Affiliation(s)
- Lauren A Sattler
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Chad Schuety
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Mark Nau
- Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, USA
| | - Daniel V Foster
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - John Hunninghake
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Tyson Sjulin
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Joshua Boster
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
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The Impact of a Comprehensive Simulation-Based Training and Certification Program on Resident Central Venous Catheter Complication Rates. Simul Healthc 2020; 16:92-97. [PMID: 32910104 DOI: 10.1097/sih.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Millions of central venous catheters (CVCs) are placed annually in the United States, many by resident physicians. Simulation training has been proposed as a means to increase resident physician competence with CVC placement and decrease the incidence of line-associated mechanical complications. We aimed to evaluate the impact of a novel simulation-based CVC training program for resident physicians on CVC-associated mechanical complication rates. We hypothesized that the CVC-related mechanical complication rates would be lower among simulation-trained residents (STRs) compared with nonsimulation, traditionally trained residents (TTRs). METHODS A retrospective chart review was performed of patients with a CVC placed by a resident physician between October 2014 and January 2017 at MedStar Georgetown University Hospital in Washington, DC. Incidence of CVC mechanical complications, including pneumothorax, hemothorax, arterial injury, or retained guidewire, were extracted from the electronic medical record and compared between STR and TTR cohorts. In contrast to TTRs who were trained to place CVCs in a supervised clinical setting, STRs underwent a CVC training program using online modules, a hands-on simulation training and testing checklist, and a series of successful supervised insertions before being credentialed to place lines independently. RESULTS Nine hundred twenty-four CVCs placed by resident physicians during the study period were analyzed. There was no statistically significant difference in total mechanical complication rates between the STRs and TTRs in this study period (2.4% vs. 2.2%, P = 1). Simulation-trained residents were more likely to use ultrasound guidance when indicated during CVC insertion compared with TTRs (94.8% vs. 70.5%, P < 0.001). CONCLUSIONS Mechanical complication rates associated with CVC insertion were similar between the simulation and TTRs and were consistent with previously published literature. These findings suggest that residents who underwent simulation training and certification demonstrated performance on par with more experienced TTRs. In addition, they were more likely to use best practices including ultrasound guidance in line placement.
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Aslam W, Lee HJ, Lamb CR. Standardizing education in interventional pulmonology in the midst of technological change. J Thorac Dis 2020; 12:3331-3340. [PMID: 32642256 PMCID: PMC7330781 DOI: 10.21037/jtd.2020.03.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Interventional pulmonology (IP) is a maturing subspecialty of pulmonary medicine. The robust innovation in technology demands standardization in IP training with both disease and technology driven training. Simulation based training should be considered a part of IP training as seen in other procedural and surgical subspecialties. Procedure volume is a component of training; however, this does not guarantee or translate into competency for learners. Basic competency skills can be assessed using standardized well validated assessment tools designed for various IP procedures including flexible bronchoscopy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA), rigid bronchoscopy and chest tube placement; however, further work is needed to validate tools in all procedures as new technologies are introduced beyond fellowship training. Currently there are at least 39 IP fellowship programs in the United States (US) and Canada which has led to improved training by accreditation of programs who meet rigorous requirements of standardized curriculum and procedural volume. The challenge is to be innovative in how we teach globally with intention and how to best integrate new evolving technology training for those not only during fellowship training but also beyond fellowship training.
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Affiliation(s)
- Waqas Aslam
- Department of Interventional Pulmonary, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Hans J Lee
- Department of Interventional Pulmonary, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carla R Lamb
- Department of Interventional Pulmonary, Lahey Hospital & Medical Center, Burlington, MA, USA
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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: 16] [Impact Index Per Article: 4.0] [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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Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology. Anesthesiology 2020; 131:908-928. [PMID: 31365369 DOI: 10.1097/aln.0000000000002827] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.
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Advancing Simulation-Based Orthopaedic Surgical Skills Training: An Analysis of the Challenges to Implementation. Adv Orthop 2019; 2019:2586034. [PMID: 31565441 PMCID: PMC6745149 DOI: 10.1155/2019/2586034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/10/2019] [Accepted: 08/03/2019] [Indexed: 01/18/2023] Open
Abstract
Simulation-based surgical skills training is recognized as a valuable method to improve trainees' performance and broadly perceived as essential for the establishment of a comprehensive curriculum in surgical education. However, there needs to be improvement in several areas for meaningful integration of simulation into surgical education. The purpose of this focused review is to summarize the obstacles to a comprehensive integration of simulation-based surgical skills training into surgical education and board certification and suggest potential solutions for those obstacles. First and foremost, validated simulators need to be rigorously assessed to ensure their feasibility and cost-effectiveness. All simulation-based courses should include clear objectives and outcome measures (with metrics) for the skills to be practiced by trainees. Furthermore, these courses should address a wide range of issues, including assessment of trainees' problem-solving and decision-making abilities and remediation of poor performance. Finally, which simulation-based surgical skills courses will become a standard part of the curriculum across training programs and which will be of value in board certification should be precisely defined. Sufficient progress in these areas will prevent excessive development of training and assessment tools with duplicative effort and large variability in quality.
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