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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.
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Affiliation(s)
- Jordan Abrams
- Mount Sinai Morningside and West Hospitals, New York, New York, USA
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Mossenson A, Livingston P, Mukwesi C, Khalid K, Martínez RR, Alferid F, Nath G, Nyirigira G, Haylock Loor C. Beyond Reframing: Painting the Truth About Vital Anesthesia Simulation Training. Anesth Analg 2024; 138:e45-e47. [PMID: 38771613 DOI: 10.1213/ane.0000000000007005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Adam Mossenson
- SJOG Midland Public and Private Hospitals, Perth, Australia, Dalhousie University, Halifax, Canada, Curtin University , Perth, Australia,
| | | | - Christian Mukwesi
- Rwanda Military Hospital, Kigali, Rwanda, University of Rwanda, Kigali, Rwanda
| | - Karima Khalid
- Muhimbili University of Health & Allied Sciences, Dar Es Salaam, Tanzania
| | | | | | - Gita Nath
- Axon Anaesthesia Associates, Hyderabad, India
| | - Gaston Nyirigira
- University of Rwanda, Kigali, Rwanda, King Faisal Hospital, Kigali, Rwanda
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Alayande BT, Forbes C, Kingpriest P, Adejumo A, Williams W, Wina F, Agbo CA, Omolabake B, Bekele A, Ismaila BO, Kerray F, Sule A, Abahuje E, Robertson JM, Yule S, Riviello R, Isichei M. Non-technical skills training for Nigerian interprofessional surgical teams: a cross-sectional survey. BMC MEDICAL EDUCATION 2024; 24:547. [PMID: 38755653 PMCID: PMC11097506 DOI: 10.1186/s12909-024-05550-8] [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: 02/02/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Non-technical skills (NTS) including communication, teamwork, leadership, situational awareness, and decision making, are essential for enhancing surgical safety. Often perceived as tangential soft skills, NTS are many times not included in formal medical education curricula or continuing medical professional development. We aimed to explore exposure of interprofessional teams in North-Central Nigeria to NTS and ascertain perceived facilitators and barriers to interprofessional training in these skills to enhance surgical safety and inform design of a relevant contextualized curriculum. METHODS Six health facilities characterised by high surgical volumes in Nigeria's North-Central geopolitical zone were purposively identified. Federal, state, and private university teaching hospitals, non-teaching public and private hospitals, and a not-for-profit health facility were included. A nineteen-item, web-based, cross-sectional survey was distributed to 71 surgical providers, operating room nurses, and anaesthesia providers by snowball sampling through interprofessional surgical team leads from August to November 2021. Data were analysed using Fisher's exact test, proportions, and constant comparative methods for free text responses. RESULTS Respondents included 17 anaesthesia providers, 21 perioperative nurses, and 29 surgeons and surgical trainees, with a 95.7% survey completion rate. Over 96% had never heard of any NTS for surgery framework useful for variable resource contexts and only 8% had ever received any form of NTS training. Interprofessional teams identified communication and teamwork as the most deficient personal skills (38, 57%), and as the most needed for surgical team improvement (45, 67%). There was a very high demand for NTS training by all surgical team members (64, 96%). The main motivations for training were expectations of resultant improved patient safety and improved interprofessional team dynamics. Week-long, hybrid training courses (with combined in-person and online components) were the preferred format for delivery of NTS education. Factors that would facilitate attendance included a desire for patient safety and self-improvement, while barriers to attendance were conflicts of time, and training costs. CONCLUSIONS Interprofessional surgical teams in the Nigerian context have a high degree of interest in NTS training, and believe it can improve team dynamics, personal performance, and ultimately patient safety. Implementation of NTS training programs should emphasize interprofessional communication and teamworking.
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Affiliation(s)
- Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.
- Surgical Equity Research Hub, Jos, Nigeria.
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
| | | | | | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Felix Wina
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Christian Agbo Agbo
- Department of Surgery, Benue State University Teaching Hospital, Markudi, Nigeria
| | - Bamidele Omolabake
- Department of Surgery, Benue State University Teaching Hospital, Markudi, Nigeria
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Bashiru O Ismaila
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Fiona Kerray
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Augustine Sule
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Egide Abahuje
- University of Rwanda, Kigali, Rwanda
- Department of Surgery, Northwestern University, Evanston, Ilinois, United States of America
| | - Jamie M Robertson
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Steven Yule
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Robert Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Mercy Isichei
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
- The Faith Alive Foundation, Jos, Nigeria
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Tuyishime E, Irakoze A, Seneza C, Fan B, Mvukiyehe JP, Kwizera J, Rosenberg N, Evans FM. The initiative for medical equity and global health (IMEGH) resuscitation training program: A model for resuscitation training courses in Africa. Afr J Emerg Med 2024; 14:33-37. [PMID: 38268932 PMCID: PMC10805636 DOI: 10.1016/j.afjem.2023.12.003] [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] [Received: 09/04/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
In high-income countries, outcomes following in hospital cardiac arrest have improved over the last two decades due to the introduction of rapid response teams, cardiac arrest teams, and advanced resuscitation training. However, in low-income countries, such as Rwanda, outcomes are still poor. This is due to multiple factors including lack of adequate resuscitation training, few trainers, and lack of equipment. To address this issue, the Initiative for Medical Equity and Global Health Equity (IMEGH), a training organization founded in 2018 by 5 local anesthesiologists has regularly taught resuscitation courses such as Basic Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support in hospitals throughout Rwanda. The aims of the organization include developing a sustainable model to offer context relevant resuscitation training courses, building a cadre of local instructors to teach on the courses, as well as engaging funding partners to help support the effort. From October 2018 until September 2022, 31 courses were run in 11 hospitals across Rwanda training 1,060 healthcare providers (mainly of non-physician anesthetists, nurses, midwives, and general practitioners). Ongoing challenges include lack of local protocols, inability to tracking resuscitation outcomes, and continued inaccessibility by many healthcare providers. Despite these challenges, the IMEGH program is an example of a successful context-relevant model and has potential to inform the design of resuscitation programs in other similar settings. This article describes the development of the IMEGH program, accomplishments as well as lessons learned, challenges, and next steps for expansion.
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Affiliation(s)
- Eugene Tuyishime
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department of Anesthesia and Perioperative Medicine, Western University, Canada
| | - Alain Irakoze
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, King Faisal Hospital, Kigali, Rwanda
| | - Celestin Seneza
- Department Anesthesia and Critical Care, Kibagabaga District Hospital, Kigali, Rwanda
| | - Bernice Fan
- School of Nursing, University of Virginia, USA
| | - Jean Paul Mvukiyehe
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, King Faisal Hospital, Kigali, Rwanda
| | - Jackson Kwizera
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, King Faisal Hospital, Kigali, Rwanda
| | - Noah Rosenberg
- Department of Emergency Medicine, University of Botswana, Gaborone, Botswana
| | - Faye M Evans
- Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
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Gower S, Mossenson A, Ndekezi JK, Livingston P. Building Global Partnerships: A Qualitative Exploration of In-Person Training for HealthCare Simulation Educators Working in Low-Resource Settings. Simul Healthc 2024:01266021-990000000-00098. [PMID: 38197675 DOI: 10.1097/sih.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Effective educational initiatives can elevate the quality of patient care globally. Simulation-based education is widely used in high-resource settings, but barriers exist to its widespread use in low-resource settings. Vital Anesthesia Simulation Training (VAST) overcomes these barriers by offering immersive, low-cost portable simulation along with simulation facilitator training. During the COVID-19 pandemic, in-person courses were stopped for more than 2 years. Postpandemic, a 3-day VAST SIMposium was hosted in Rwanda to unite 42 VAST facilitators from 12 widespread countries to introduce new and revised course materials and to rejuvenate dormant skills. The purpose of this study was to explore how the VAST SIMposium influenced perceived development of skills, confidence, and engagement in a community of practice for simulation educators working in low-resource settings. METHODS This qualitative study involved in-depth interviews with a purposive sample of 16 VAST SIMposium attendees. Transcripts of audio recordings were analyzed using inductive thematic analysis. RESULTS Six themes were identified during data analysis: 1) Diversity with shared passion for medical education; 2) Supportive in-person learning environment; 3) Simulation-based education relevant to low-resource settings; 4) Camaraderie; 5) Building knowledge, skills, and confidence; and 6) Being part of a community of practice. CONCLUSION The SIMposium rejuvenated passion, knowledge, skills, and, most importantly, strengthened global connections and partnerships. These collaborations will benefit areas that are underrepresented in simulation and will ultimately improve patient outcomes. A SIMposium of this format is an efficient and effective way to foster sustainable global dissemination of simulation-based global health education.
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Affiliation(s)
- Shelley Gower
- From the School of Nursing (S.G.), Curtin University, Perth, Australia; Curtin Medical School (A.M.), Curtin University, Perth, Australia; Department of Anesthesia (A.M.), SJOG Public and Private Hospital, Perth, Australia; Department of Anesthesia, Pain Management, and Perioperative Medicine (A.M., P.L.), Dalhousie University, Halifax, Canada; Department of Anesthesia (J.K.N.), University of Rwanda, Rwanda; and Department of Anesthesia and Critical Care (J.K.N.), King Faisal Hospital, Kigali, Rwanda
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Parab SY, Ranganathan P, Shetmahajan M, Malde A. Role of simulation-based training in thoracic anaesthesia. Indian J Anaesth 2024; 68:58-64. [PMID: 38406334 PMCID: PMC10893814 DOI: 10.4103/ija.ija_1235_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 02/27/2024] Open
Abstract
Simulation-based training (SBT) aims to acquire technical and non-technical skills in a simulated fashion without harming the patient. Simulation helps the anaesthesiologist acquire procedural competence and non-technical abilities. In thoracic anaesthesia, various simulators are available with varying degrees of fidelity and costs. Apart from improving bronchoscopy-related skills, other potential applications of SBT include the practice of lung isolation in normal and difficult airway scenarios, troubleshooting complications during surgeries, and certification of the proficiency of anaesthesiologists. A pragmatic approach is required for choosing the simulator based on its availability, cost, and benefits. Although the literature supports SBT to improve procedural skills, retention of the skills and their translation into improving clinical outcomes remain largely unproven. Randomised, controlled studies targeting the effect of SBT on the improvement of clinical outcomes of patients are needed to prove their worth.
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Affiliation(s)
- Swapnil Y. Parab
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Dr. E Borges Road, Parel, Mumbai, Maharashtra, India
| | - Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Dr. E Borges Road, Parel, Mumbai, Maharashtra, India
| | - Madhavi Shetmahajan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Dr. E Borges Road, Parel, Mumbai, Maharashtra, India
| | - Anila Malde
- Department of Anaesthesiology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, Maharashtra, India
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Savoldelli GL, Burlacu CL, Lazarovici M, Matos FM, Østergaard D. Integration of simulation-based education in anaesthesiology specialist training: Synthesis of results from an Utstein Meeting. Eur J Anaesthesiol 2024; 41:43-54. [PMID: 37872824 PMCID: PMC10720798 DOI: 10.1097/eja.0000000000001913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Despite its importance in education and patient safety, simulation-based education and training (SBET) is only partially or poorly implemented in many countries, including most European countries. The provision of a roadmap may contribute to the development of SBET for the training of anaesthesiologists. OBJECTIVE To develop a global agenda for the integration of simulation into anaesthesiology specialist training; identify the learning domains and objectives that are best achieved through SBET; and to provide examples of simulation modalities and evaluation methods for these learning objectives. DESIGN Utstein-style meeting where an expert consensus was reached after a series of short plenary presentations followed by small group workshops, underpinned by Kern's six-step theoretical approach to curriculum development. SETTING Utstein-style collaborative meeting. PARTICIPANTS Twenty-five participants from 22 countries, including 23 international experts in simulation and two anaesthesia trainees. RESULTS We identified the following ten domains of expertise for which SBET should be used to achieve the desired training outcomes: boot camp/initial training, airway management, regional anaesthesia, point of care ultrasound, obstetrics anaesthesia, paediatric anaesthesia, trauma, intensive care, critical events in our specialty, and professionalism and difficult conversations. For each domain, we developed a course template that defines the learning objectives, instructional strategies (including simulation modalities and simulator types), and assessment methods. Aspects related to the practical implementation, barriers and facilitators of this program were also identified and discussed. CONCLUSIONS We successfully developed a comprehensive agenda to facilitate the integration of SBET into anaesthesiology specialist training. The combination of the six-step approach with the Utstein-style process proved to be extremely valuable in supporting content validity and representativeness. These results may facilitate the implementation and use of SBET in several countries. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Georges L Savoldelli
- From the Division of Anaesthesia, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine. Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland (GLS), University College Dublin, School of Medicine, Surgery and Surgical Specialties and Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland (CLB), Institute for Emergency Medicine and Management in Medicine, Ludwig Maximilians University Hospital, Munich, Germany (ML), Anaesthesiology Department, Centro Hospitalar e Universitário de Coimbra, CHUC, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal and Clinic Academic Center of Coimbra, CACC, Coimbra, Portugal (FMM), Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and Faculty of Medicine, University of Copenhagen (DO), European Society of Anaesthesiology and Intensive Care (ESAIC) Simulation Committee, https://www.esaic.org/about/committees/simulation-committee/ (GLS, CLB, FMM, DO), Society for Simulation in Europe (SESAM) Executive Committee, https://www.sesam-web.org (ML, FMM), World Federation of Societies of Anaesthesiologists (WFSA) Education Committee, https://wfsahq.org/about/people/committees/education-committee/ (DO), See attached list for the affiliations of the investigators of the Utstein Simulation Study Group (USSG)
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Gathuya Z, Nabukenya MT, Aaron O, Gray R, Evans FM. Children's Anaesthesia and perioperative care challenges, and innovations. Semin Pediatr Surg 2023; 32:151355. [PMID: 38043262 DOI: 10.1016/j.sempedsurg.2023.151355] [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: 12/05/2023]
Abstract
The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2-4) Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5-7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).
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Affiliation(s)
- Z Gathuya
- Department of Anesthesia, The Nairobi Hospital, Nairobi, Kenya.
| | - M T Nabukenya
- Department of Anesthesia, Makerere University College of Health Sciences, Uganda
| | - O Aaron
- Department of Anesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - R Gray
- Division of Paediatric Anaesthesia, Division of Global Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 27St Michaels Rd, Tamboerskloof, Cape Town, 8001, South Africa
| | - F M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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9
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Mossenson A, Upadhye V, Livingston P. Developing simulation educator skills globally through the Vital Anaesthesia Simulation Training community of practice. Br J Anaesth 2023; 131:e190-e192. [PMID: 37858480 DOI: 10.1016/j.bja.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Adam Mossenson
- Department of Anaesthesia, SJOG Midland Public and Private Hospitals, Perth, WA, Australia; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada; Curtin Medical School, Curtin University, Perth, WA, Australia.
| | - Vaibhavi Upadhye
- Department of Anaesthesiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Patricia Livingston
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Skelton T, Nizeyimana F, Pendergrast J, Hagumimana J, Masaisa F, Kanyamuhunga A, Gashaija C, Callum J, Pavenski K, Khandelwal A, Lieberman L, Chargé S, Kapitany C, Morgan M, Meirovich H, Lin Y. Transfusion medicine education delivery in Rwanda: Adapting Transfusion Camp to a resource-limited setting. Transfusion 2023; 63:2159-2169. [PMID: 37688306 DOI: 10.1111/trf.17531] [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: 05/23/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Due to few teaching faculty, resource-limited settings may lack the education curricula providers need for safe practice. As safe surgery becomes an increasing priority worldwide, it is essential to improve access to critical education content including in transfusion medicine. Transfusion Camp is a longitudinal curriculum, shown to increase knowledge in postgraduate trainees. The objective was to develop a sustainable bilateral partnership between Rwanda and Canada, and to integrate Transfusion Camp into the existing curriculum of the School of Medicine and Pharmacy at University of Rwanda. METHODS A Transfusion Camp pilot course was initiated through collaboration of experts in Rwanda and Canada. Planning occurred over 6 months via online and in-person meetings. Canadian teaching faculty adapted course content via iterative discussion with Rwandan faculty. Final content was delivered through online pre-recorded lectures by Canadian Faculty, and in-person small-group seminars by Rwandan Faculty. Project feasibility was assessed through structured evaluation and informal debriefing. RESULTS Twenty-seven postgraduate trainees were present for the pilot course, of whom 21 (78%) submitted evaluation forms. While the structure and content of the adapted Transfusion Camp curriculum were well-received, the majority of respondents indicated a preference for in-person rather than pre-recorded lectures. Debriefing determined that future courses should focus on continuing education initiatives aimed at physicians entering or already in independent practice. CONCLUSION A partnership between universities and blood operators in high-resource and resource-limited countries results in a transfusion medicine curriculum that is locally applicable, multidisciplinary, and supportive of learning benefitting the learners and educators alike.
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Affiliation(s)
- Teresa Skelton
- Department of Anesthesiology, Pharmacology, and Therapeutics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Francoise Nizeyimana
- Department of Anesthesia and Critical Care, Kigali University Teaching Hospital, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Jacob Pendergrast
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Justin Hagumimana
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Florence Masaisa
- Department of Internal Medicine, Kigali University Teaching Hospital, University of Rwanda, Kigali, Rwanda
| | - Aimable Kanyamuhunga
- Department of Pediatrics, Kigali University Teaching Hospital, University of Rwanda, Kigali, Rwanda
| | - Christopher Gashaija
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Jeannie Callum
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Aditi Khandelwal
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Lani Lieberman
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Sophie Chargé
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Casey Kapitany
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Mary Morgan
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Harley Meirovich
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Mossenson AI, Ocholi D, Gower S, Livingston PL. Skill Translation Following the Vital Anesthesia Simulation Training Facilitator Course: A Qualitative Study. Anesth Analg 2023; 137:551-558. [PMID: 37043403 DOI: 10.1213/ane.0000000000006468] [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: 04/13/2023]
Abstract
BACKGROUND Simulation-based education (SBE) is common in resource-rich locations, but barriers exist to widespread implementation in low-resource settings (LRSs). Vital Anesthesia Simulation Training (VAST) was developed to offer low-cost, immersive simulation to teach core clinical practices and nontechnical skills to perioperative health care teams. To promote sustainability, courses in new locations are preceded by the VAST Facilitator Course (VAST FC) to train local faculty. The purpose of this study was to explore the experiences of VAST FC graduates in translating postcourse knowledge and skills into their workplaces. METHODS This qualitative study used focus group interviews with 24 VAST FC graduates (from 12 low- and middle-income and 12 high-income countries) to explore how they had applied new learning in the workplace. Focus groups were conducted by videoconferencing with data transcribed verbatim. Data were analyzed using inductive thematic analysis. RESULTS Enabler themes for knowledge and skill translation following facilitator training were (1) the structured debriefing framework, (2) the ability to create a supportive learning environment, and (3) being able to meaningfully discuss nontechnical skills. Two subthemes within the debriefing framework were (1.1) knowledge of conversational techniques and (1.2) having relevance to clinical debriefing. Barrier themes limiting skill application were (1) added time and effort required for comprehensive debriefing, (2) unsupportive workplaces, and (3) lack of opportunities for mentorship and practice postcourse. CONCLUSIONS Participants found parallels between SBE debriefing conversations, clinical event debriefing, and feedback conversations and were able to apply knowledge and skills in a variety of settings post course. This study supports the relevance of simulation facilitator training for SBE in LRSs.
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Affiliation(s)
- Adam I Mossenson
- From the SJOG Midland Public and Private Hospitals, Perth, Western AustraliaAustralia
- Curtin University, Perth, Western Australia, Australia
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Deborah Ocholi
- Faculty of Medicine, Dalhousie University, HalifaxNova Scotia, Canada
| | - Shelley Gower
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Patricia L Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Tuyishime E, Mossenson A, Livingston P, Irakoze A, Seneza C, Ndekezi JK, Skelton T. Resuscitation team training in Rwanda: A mixed method study exploring the combination of the VAST course with Advanced Cardiac Life Support training. Resusc Plus 2023; 15:100415. [PMID: 37363124 PMCID: PMC10285628 DOI: 10.1016/j.resplu.2023.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction The influence of non-technical skills training on resuscitation performance in low-resource settings is unknown. This study investigates combining the Vital Anaesthesia Simulation Training Course with Advanced Cardiac Life Support training on resuscitation performance in Rwanda. Methods Participants in this mixed method study are members of resuscitation teams in three district hospitals in Rwanda. The intervention was participation in a 2-day Advanced Cardiac Life Support course followed by the 3-day Vital Anaesthesia Simulation Training Course. Quantitative primary endpoints were time to initiation of cardiopulmonary resuscitation, time to epinephrine administration, and time to defibrillation. Qualitative data on workplace implementation were gathered during focus groups held 3-months post-intervention. Results Forty-seven participants were recruited. Quantitative data showed a statistically significant decrease in time to cardiopulmonary resuscitation, epinephrine administration, and defibrillation from pre- to post-Advanced Cardiac Life Support, with times of [43.3 (49.7) seconds] versus [16.5 (20) sec], p = <0.001; [137.3 (108.9) sec] versus [51.3 (37.9)], p = <0.001; and [218.5 (105.8) sec] versus [110.8 (87.1) sec], p = <0.001; respectively. These improvements were maintained following the Vital Anaesthesia Simulation Training Course, and at 3-month retention testing. Qualitative analysis highlighted five key themes: ability to initiate cardiopulmonary resuscitation; team coordination for task allocation; empowerment; desire for training and mentorship; and advocacy for system improvement. Conclusion A modified 2-day Advanced Cardiac Life Support course improved resuscitation time indicators with retention 3-months later. Combining the Vital Anaesthesia Simulation Training Course and Advanced Cardiac Life Support led to better team coordination, empowerment to act, and advocacy for system improvement. This pairing of courses has promise for improving Advanced Cardiac Life Support skills amongst healthcare workers in low-resource settings.ClinicalTrials.gov Identifier: NCT05278884.
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Affiliation(s)
- Eugene Tuyishime
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, University of Botswana, Botswana
- Department of Anesthesia and Perioperative Medicine, Western University, Ontario, Canada
| | - Adam Mossenson
- Department of Anaesthesia, SJOG Public and Private Hospital, Perth, Western Australia
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
- Curtin University, Perth, Western Australia, Australia
| | - Patricia Livingston
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
| | - Alain Irakoze
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
| | | | | | - Teresa Skelton
- Department of Anesthesia and Pain Medicine, the Hospital for Sick Children, University of Toronto, Canada
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13
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Vasilopoulos T, Fahy BG. ANTS (Anesthetists' non-technical skills) and "ANT"icipation of their potential. J Clin Anesth 2023; 85:111041. [PMID: 36566647 DOI: 10.1016/j.jclinane.2022.111041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
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14
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MacLennan K, Minehart RD, Vasco M, Eley VA. Simulation-based training in obstetric anesthesia: an update. Int J Obstet Anesth 2023; 54:103643. [PMID: 36933323 DOI: 10.1016/j.ijoa.2023.103643] [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: 01/18/2023] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
In this update we explore the current applications of simulation in obstetric anesthesia, describe what is known regarding its impacts on care and consider the different settings in which simulation programs are required. We will introduce practical strategies, such as cognitive aids and communication tools, that can be applied in the obstetric setting and share ways in which a program might apply these tools. Finally, we provide a list of common obstetric emergencies essential for a program's curriculum and common teamwork pitfalls to address within a comprehensive obstetric anesthesia simulation program.
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Affiliation(s)
| | - R D Minehart
- Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - M Vasco
- Universidad CES, Medellín, Colombia
| | - V A Eley
- Royal Brisbane and Women's Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
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15
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Dohlman LE, Thakkar N, Jivanelli B, Pakala S, Brouillette MA. Regional anesthesia global health collaborations- a scoping review of current intervention methods. Curr Opin Anaesthesiol 2022; 35:647-653. [PMID: 35942724 DOI: 10.1097/aco.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Perioperative anesthesia-related mortality is significantly higher in low-resource compared to high-resource countries. Regional anesthesia techniques can provide safety, cost, and access benefits when compared to general anesthesia in these settings but is underutilized primarily due to a lack of experienced educators and training opportunities. Academic institutions and international organizations are attempting to fill this educational gap through collaborations, but these efforts need examination for best practices going forward. RECENT FINDINGS Most collaborative anesthesia interactions between high and low resource areas have occurred between North America or Europe, and Africa or Asia and a majority have involved an educational intervention. Only 7% of the studies used a recognized framework to evaluate the intervention used in their research, such as the Kirkpatrick, REAIM or CFIR method. All recent studies reviewed reported a positive impact from educational collaborations. Only 7% of interventions have had a primary focus on regional anesthesia and most were reported between 2016 and 2022. SUMMARY Robust reports on international collaborations providing capacity enhancing educational interventions in regional anesthesia have increased in recent years but are still rare and should be encouraged going forward. Short courses supported by high-resource countries can be effective in low-resource areas when partnerships produce curricula that are well designed.
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Affiliation(s)
- Lena E Dohlman
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Niharika Thakkar
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery
| | - Bridget Jivanelli
- Kim Barrett Memorial Library, HSS Education Institute, Hospital for Special Surgery
| | - Swetha Pakala
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery.,Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Mark A Brouillette
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery.,Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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16
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Abahuje E, Johnson J, Halverson A, Stulberg JJ. Intraoperative Assessment of Non-Technical Skills for Surgeons (NOTSS) and Qualitative Description of their Effects on Intraoperative Performance. JOURNAL OF SURGICAL EDUCATION 2022; 79:1237-1245. [PMID: 35637141 DOI: 10.1016/j.jsurg.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/08/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aims of this study were (1) to evaluate the feasibility of using the Non-Technical Skills for Surgeons (NOTSS) rating tool in assessing surgeons' non-technical skills behaviors in live operations, and (2) to describe the effect of NOTSS on intraoperative performance. SETTING DESIGN This study was conducted in an academic hospital in North America. Two observers independently conducted direct non-participant observations using the NOTSS rating tool to assess non-technical skills, and to document examples of effective or ineffective non-technical skills behaviors. Observers took field notes to document non-technical skill gaps that were not captured by the NOTSS rating tool, and situations or scenarios that presented challenges for accurate assessment. Interclass correlation estimates and 95% confidence intervals were calculated to assess the validity of the NOTSS rating tool. Deductive thematic qualitative data analysis was used for field notes and NOTSS behavior descriptions. PARTICIPANTS Participants were general surgeons performing either minimally invasive (robotic assisted or laparoscopic surgery), or open procedures. RESULTS We observed 18 surgeries, involving 6 surgeons, 11 residents and one fellow resulting in 37 hours of direct observations. The mean NOTSS score was 3.8 (SD 0.41) for situation awareness, 3.75 (SD 0.47) for decision-making, 3.71 (SD 0.39) for communication and teamwork, and 3.76 (SD 0.38) for leadership. The inter-rater reliability ranged between 0.65 and 0.80 for each NOTSS categories. The observers documented examples of effective non-technical skills behaviors and examples of behaviors that need improvement. Furthermore, we described the effect of each observed behavior on intraoperative performance. One challenge to NOTSS use in live surgery was that observers had to infer situation awareness, decision-making, and coping with pressure as these were not easily observed without attending surgeons articulating their underlying thought process. CONCLUSION The use of the NOTSS tool in live surgery is a valid and practical tool to document observed behaviors and their effect on intraoperative performance in order to provide constructive feedback to surgeons. One notable limitation is that without specific articulation by the surgeon of their underlying thought process the observer must infer specific elements. By documenting specific real-world events with high inter-rater reliability and adequate surgeon score variation the process can be used to provide useful feedback for improvement.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Julie Johnson
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Amy Halverson
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jonah J Stulberg
- Department of Surgery, University of Texas, Health Science Center at Houston, Houston, Texas
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17
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Affiliation(s)
- Angela Enright
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia.,Department of Anesthesiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland New Zealand, Auckland City Hospital, Auckland, New Zealand
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18
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Kojima T, Nakahari H, Kawatsu Y. Blindfolded in-situ simulation can help improve non-technical skills in anesthesia emergencies. J Clin Anesth 2022; 81:110888. [PMID: 35700663 DOI: 10.1016/j.jclinane.2022.110888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-City, Aichi, Japan; Division of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Hirofumi Nakahari
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-City, Aichi, Japan
| | - Yuta Kawatsu
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-City, Aichi, Japan
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19
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Lavoie P, Lapierre A, Maheu-Cadotte MA, Fontaine G, Khetir I, Bélisle M. Transfer of Clinical Decision-Making-Related Learning Outcomes Following Simulation-Based Education in Nursing and Medicine: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:738-746. [PMID: 34789663 DOI: 10.1097/acm.0000000000004522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Simulation is often depicted as an effective tool for clinical decision-making education. Yet, there is a paucity of data regarding transfer of learning related to clinical decision-making following simulation-based education. The authors conducted a scoping review to map the literature regarding transfer of clinical decision-making learning outcomes following simulation-based education in nursing or medicine. METHOD Based on the Joanna Briggs Institute methodology, the authors searched 5 databases (CINAHL, ERIC, MEDLINE, PsycINFO, and Web of Science) in May 2020 for quantitative studies in which the clinical decision-making performance of nursing and medical students or professionals was assessed following simulation-based education. Data items were extracted and coded. Codes were organized and hierarchized into patterns to describe conceptualizations and conditions of transfer, as well as learning outcomes related to clinical decision-making and assessment methods. RESULTS From 5,969 unique records, 61 articles were included. Only 7 studies (11%) assessed transfer to clinical practice. In the remaining 54 studies (89%), transfer was exclusively assessed in simulations that often included one or more variations in simulation features (e.g., scenarios, modalities, duration, and learner roles; 50, 82%). Learners' clinical decision-making, including data gathering, cue recognition, diagnoses, and/or management of clinical issues, was assessed using checklists, rubrics, and/or nontechnical skills ratings. CONCLUSIONS Research on simulation-based education has focused disproportionately on the transfer of learning from one simulation to another, and little evidence exists regarding transfer to clinical practice. The heterogeneity in conditions of transfer observed represents a substantial challenge in evaluating the effect of simulation-based education. The findings suggest that 3 dimensions of clinical decision-making performance are amenable to assessment-execution, accuracy, and speed-and that simulation-based learning related to clinical decision-making is predominantly understood as a gain in generalizable skills that can be easily applied from one context to another.
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Affiliation(s)
- Patrick Lavoie
- P. Lavoie is assistant professor, Faculty of Nursing, Université de Montréal, and researcher, Montreal Heart Institute, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0001-8244-6484
| | - Alexandra Lapierre
- A. Lapierre is a doctoral candidate, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-8704-4940
| | - Marc-André Maheu-Cadotte
- M.-A. Maheu-Cadotte is a doctoral candidate, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0003-3190-0901
| | - Guillaume Fontaine
- G. Fontaine is a postdoctoral research fellow, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0002-7806-814X
| | - Imène Khetir
- I. Khetir is a master's student, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Marilou Bélisle
- M. Bélisle is associate professor, Faculty of Education, Université de Sherbrooke, Longueuil, Quebec, Canada
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20
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O’Brien N, Shaw A, Flott K, Leatherman S, Durkin M. Safety in fragile, conflict-affected, and vulnerable settings: An evidence scanning approach for identifying patient safety interventions. J Glob Health 2022; 12:04018. [PMID: 35265329 PMCID: PMC8876158 DOI: 10.7189/jogh.12.04018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The number of people living in fragile, conflict-affected, and vulnerable (FCV) settings is growing rapidly and attention to achieving universal health coverage must be accompanied by sufficient focus on the safety of care for universal access to be meaningful. Healthcare workers in these settings are working under extreme conditions, often with insufficient contextualized evidence to support decision-making. Recognising the relative paucity of, and methodological issues in gathering evidence from these settings, the evidence scanning described in this paper considered which patient safety interventions might offer the ‘better bet’, eg, the most effective and appropriate intervention in FCV settings. Methods An evidence scanning approach was used to examine the literature. The search was limited to FCV settings and low-income settings as defined by the World Bank, but if a systematic review included a mix of evidence from FCV/low income settings, as well as low-middle income settings, it was included. The search was conducted in English and limited to studies published from 2003 onwards, utilising Google Scholar as a publicly accessible database and further review of the grey literature, with specific attention to the outputs of non-governmental organisations. The search and subsequent analysis were completed between April and June 2020. Results The majority of studies identified related to strengthening infection prevention and control which was also found to be the ‘better bet’ intervention that could generalise to other settings, be most feasible to implement, and most effective for improving patient care and associated outcomes. Other prioritized interventions include risk management, with contributing elements such as reporting, audits, and death review processes. Conclusions Infection prevention and control interventions dominate in the literature for multiple reasons including strength of evidence, acceptability, feasibility, and impact on patient and health worker well-being. However, there is an urgent need to further develop the evidence base, specialist knowledge, and field guidance on a range of other patient safety interventions such as education and training, patient identification, subject specific safety actions, and risk management.
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Affiliation(s)
- Niki O’Brien
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexandra Shaw
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Kelsey Flott
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Sheila Leatherman
- UNC Gillings School of Global Public Health, University of North Carolina, North Carolina, USA
| | - Mike Durkin
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
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21
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Gray RM, Cronjé L, Kalipa MN, Lee CA, Evans FM. Paediatric anaesthesia care in Africa: challenges and opportunities. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.1.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- RM Gray
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
- Division of Global Surgery, Department of Surgery, University of Cape Town,
South Africa
| | - L Cronjé
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal,
South Africa
| | - MN Kalipa
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria,
South Africa
| | - CA Lee
- Department of Paediatric Anaesthesia, Nelson Mandela Children’s Hospital and Department of Anaesthesiology, University of the Witwatersrand,
South Africa
| | - FM Evans
- Boston Children’s Hospital, Department of Anesthesiology, Critical Care, and Pain Medicine and Harvard Medical School,
United States of America
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22
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Lindegger DJ, Abahuje E, Ruzindana K, Mwachiro E, Karonkano GR, Williams W, Ntakiyiruta G, Riviello R, Yule S, Paterson-Brown S. Strategies for Improving Quality and Safety in Global Health: Lessons From Nontechnical Skills for Surgery Implementation in Rwanda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:481-486. [PMID: 34593575 PMCID: PMC8514020 DOI: 10.9745/ghsp-d-21-00042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Egide Abahuje
- Feinberg Medical School, Northwestern University, Chicago, IL, USA.,University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Kenneth Ruzindana
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | - Wendy Williams
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Robert Riviello
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Steven Yule
- NHS Lothian University Hospitals Division, Edinburgh, Scotland
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23
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Montrucchio G, Brazzi L. Are we at a turning point for disaster medicine education? The SIAARTI Academy Critical Emergency Medicine course experience. Minerva Anestesiol 2021; 87:1161-1163. [PMID: 34468114 DOI: 10.23736/s0375-9393.21.16008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, Turin, Italy - .,Department of Anesthesiology, Intensive Care and Emergency, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy.,Department of Anesthesiology, Intensive Care and Emergency, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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Abahuje E, Bartuska A, Koch R, Youngson G, Ntakiyiruta G, Williams W, Dias RD, Rosu C, Yule S, Riviello R. Understanding Barriers and Facilitators to Behavior Change After Implementation of an Interdisciplinary Surgical Non-Technical Skills Training Program in Rwanda. JOURNAL OF SURGICAL EDUCATION 2021; 78:1618-1628. [PMID: 33516750 DOI: 10.1016/j.jsurg.2021.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The aim of this study was to understand the challenges faced by Rwandan surgical providers, who had undergone NOTSS training, to apply these nontechnical skills during subsequent operative surgery. SETTING DESIGN A sequential exploratory mixed method study design was used to assess how participants who took the NOTSS in Rwanda applied nontechnical skills in surgical care delivery. The qualitative phase of this study deployed a constructivist grounded theory approach. Findings from the qualitative phase were used to build a quantitative survey tool that explored themes that emerged from the first phase. PARTICIPANTS Participants were nurses and resident from the departments of Surgery, Anesthesia, Obstetric, and Gynecology, from the University of Rwanda who attended the NOTSS course in March 2018. RESULTS A total of 25 participants and 49 participants were respectively enrolled in the qualitative phase and quantitative phase. Participants noted that nontechnical skills implementation in clinical practice was facilitated by working with other personnel also trained in NOTSS, anticipation, and preparation ahead of the time; while lack of interdisciplinary communication, hierarchy, work overload, and an inconsistently changing environment compromised nontechnical skills implementation. Nontechnical skills were useful both inside and outside the operating. Participants reported that nontechnical skills implementation resulted in improved team dynamics, safer patient care, and empowerment. CONCLUSION Surgical care providers who took the NOTSS course subsequently implemented nontechnical skills both inside and outside of the OR. Human and system-based factors affected the implementation of nontechnical skills in the clinical setting.
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Affiliation(s)
- Egide Abahuje
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, College of Medicine and Health Sciences, Kigali-Rwanda; MGH Institute of Health Professions, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Andrew Bartuska
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Rachel Koch
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - George Youngson
- Royal College of Surgeons of Edinburgh, Edinburgh, Scotland- United Kingdom
| | | | - Wendy Williams
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Claudia Rosu
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Steven Yule
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland-United Kingdom
| | - Robert Riviello
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, College of Medicine and Health Sciences, Kigali-Rwanda; Department of Surgery, Harvard Medical School, Boston, Massachusetts
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25
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Mossenson AI, Bailey JG, Whynot S, Livingston P. Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings. Anesth Analg 2021; 133:215-225. [PMID: 34127590 DOI: 10.1213/ane.0000000000005584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development. METHODS This qualitative study used in-depth interviews to explore VAST facilitators' perspectives on attributes and practices of effective simulation in resource-limited settings. Twenty VAST facilitators were purposively sampled and consented to be interviewed. They represented 6 low- and middle-income countries (LMICs) and 3 HICs. Interviews were conducted using a semistructured interview guide. Data analysis involved open coding to inductively identify themes using labels taken from the words of study participants and those from the relevant literature. RESULTS Emergent themes centered on 4 categories: Persona, Principles, Performance and Progression. Effective VAST facilitators embody a set of traits, style, and personal attributes (Persona) and adhere to certain Principles to optimize the simulation environment, maximize learning, and enable effective VAST Course delivery. Performance describes specific practices that well-trained facilitators demonstrate while delivering VAST courses. Finally, to advance toward competency, facilitators must seek opportunities for skill Progression.Interwoven across categories was the finding that effective VAST facilitators must be cognizant of how context, culture, and language may impact delivery of SBE. The complexity of VAST Course delivery requires that facilitators have a sensitive approach and be flexible, adaptable, and open-minded. To progress toward competency, facilitators must be open to self-reflection, be mentored, and have opportunities for practice. CONCLUSIONS The results from this study will help to develop a simulation facilitator evaluation tool that incorporates cultural sensitivity, flexibility, and a participant-focused educational model, with broad relevance across varied resource-limited environments.
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Affiliation(s)
- Adam I Mossenson
- From the Department of Anaesthesia, SJOG Midland Public and Private Hospitals, Dalhousie University, Curtin University, Perth, Western Australia
| | - Jonathan G Bailey
- Department of Anesthesia, Pain Management, and Perioperative Medicine
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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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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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: 8] [Impact Index Per Article: 2.7] [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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