Simulation and anaesthesia

Faculty development programmes in simulation-based teaching: An exploration of current practices

Background and Aims

Simulation-based teaching (SBT) has become integral to healthcare education, offering a dynamic and immersive learning experience for bridging theoretical knowledge with real-world clinical practice. Faculty members play a crucial role in shaping the effectiveness of simulation-based education, necessitating the implementation of comprehensive faculty development programmes. This scoping review explores existing literature on training programmes for simulation-based teaching, focusing on strategies employed and the overall impact on educators and the quality of simulation-based education.

Methods

The scoping review comprised five sequential steps: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarising, and reporting the results. The research questions focused on existing practices and approaches in faculty development for simulation-based teaching, challenges or barriers reported, and the effectiveness of utilised methods and strategies.

Results

A systematic search of databases yielded 13 studies meeting inclusion criteria out of 1570 initially screened papers. These studies provided insights into various aspects of faculty development programmes, including their nature, duration, and participant profiles. Despite the diversity in approaches, detailed, specialty-specific programmes were scarce, especially in anaesthesiology. Challenges, while implicit, lacked explicit exploration. Most studies reported positive outcomes, emphasising achievement of learning objectives, appreciable course content, and relevance to teaching practices.

Conclusion

This scoping review describes the existing literature regarding the faculty training or development programmes related to SBT. The programmes target various health professionals and have a wide range of durations. The need for such a programme targeting anaesthesiologists is emphasised.

Integration of simulation-based teaching in anaesthesiology curriculum

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

A Comprehensive Analysis and Review of Artificial Intelligence in Anaesthesia

In the field of anaesthesia, artificial intelligence (AI) has become a game-changing technology. Applications of AI include keeping records, monitoring patients, calculating and administering drugs, and carrying out mechanical procedures. This article explores the current uses, challenges, and prospective applications of AI in anaesthesia practices. This review discusses AI-supported systems like anaesthesia information management systems (AIMS), mechanical robots for carrying out procedures, and pharmacological models for drug delivery. AIMS has helped in automated record-keeping, predicting bad events, and monitoring the vital signs of the patient. Their application has a vital role in improving the efficacy of anaesthesia management and patient safety. The application of AI in anaesthesia comes with its own unique difficulties. Noteworthy obstacles include issues with data quantity and quality, technical limitations, and moral and legal dilemmas. The key to overcoming these barriers is to set guidelines for the ethical use of AI in healthcare, improve the reliability and comprehension of AI systems, and certify the health data precision and security. AI has very bright potential. Exciting future directions include developments in AI and machine learning thus development of new applications, and the possible enhancement in training and education. Potential research areas include the application of AI to chronic disease management, pain management, and the reinforcement of anaesthesiologists' education. AI could be used to design authentic lifelike training simulations and individualized student feedback systems, hence transforming anaesthesia education and training methodology. For this review, we conducted a PubMed, Google Scholar, and Cochrane Database search in 2022-2023 and retrieved articles on AI and its uses in anaesthesia. Recommendations for future research and development include strengthening the safety and reliability of health data, building a better understanding of AI systems, and looking into new areas of use. The power of AI can be used to innovate anaesthesia practices by concentrating on these areas.

The changing face of postgraduate anaesthesia teaching curriculum: Need of the hour!

The speciality of anaesthesiology is evolving rapidly. The recent pandemic witnessed anaesthesiologists as the front-liners catering not only as critical care physicians but also as trainers and even administrators. Today, anaesthesiologists are required to have not just sound clinical knowledge but also proficiency in skills and techniques and aptitude for leadership. The recently introduced competency-based postgraduate training programme for anaesthesiology in India with its specific learning objectives envisages the creation of competent specialists with a broad range of skills who are competent not only to handle effectively medical problems but also acquire the basic teaching skills, communication skills and leadership qualities. The curriculum marks a paradigm shift from university-based, passive, teacher-centric to student-centric, active teaching-learning methods including problem-based and self-directed learning. The mindset, lack of adequately trained faculty, infrastructure, learning resources and time constraints form the major impediment in the successful implementation of the new curriculum.

Newer teaching-learning methods and assessment modules in anaesthesia education

The National Medical Commission in its recent guidelines has stated that postgraduate training in anaesthesiology should have clear objectives and be competency based. This means that the existing teaching–learning (TL) methods need a major face-lift. E-learning and blended learning including learning management systems, virtual classrooms, app-based learning, flipped classroom, podcasts, webinars, web-based collaborative education, reflective feedback, problem-based discussions and mentorship are some newer TL methods that can be adopted. Simulation can help teach technical and non-technical skills such as leadership, teamwork and communication. In line with TL methods, newer assessment methods have to be applied to revolutionise postgraduate anaesthesia education. Formative assessment and assessment of clinical skills are important and to do this, workplace-based assessment methods such as mini-clinical evaluation exercise, direct observation of procedural skills, multisource feedback, logbook and E-portfolio can be applied. Objective structured clinical examination, simulation-based assessment and E-assessment are other useful evaluation methods.

Effectiveness of a Simulation-Based Training Program in Improving the Preparedness of Health Care Workers Involved in the Airway Management of COVID-19 Patients

Background Coronavirus disease 2019 (COVID-19) has currently emerged as a global threat and a significant public health issue. The role of simulation-based training (SBT) during such a pandemic becomes more relevant for teaching a team approach and building capacity especially when there is a threat to health care workers due to aerosol generation and there is a huge demand for manpower during the pandemic. Objective To assess the effectiveness of a simulation-based training program in improving knowledge and concept of teamwork of health care workers involved in airway management of suspected or confirmed COVID-19 patients. Methods After institutional review committee approval, a prospective analytical study was conducted in the department of medical education on participants from various specialties undergoing COVID-19 airway training. The purpose of the study was to assess team dynamics during simulation scenarios and compare test scores at baseline, immediately post-training, and seven days post-training (using online forms). Scores were compared using the Friedman test followed by post-hoc testing. Sub-group comparison was done using an unpaired t-test. Results Median scores were significantly higher in the immediate post-training test and seven days post-training test (online) compared to baseline pretest scores in the overall participant group and in individual sub-groups. There was no significant difference in immediate versus seven-day post-training test scores overall and in all subgroups. In the sub-group comparisons, median improvement in score was significantly better in the non-anesthesia group and in the resident group. It was observed that team performance in terms of role clarity, closed-loop communication, and idea acceptance improved substantially during the subsequent scenarios. Conclusion Simulation-based training was effective in improving knowledge and team dynamics amongst health care workers regarding airway management in COVID-19 patients, with retention of up to one week. Similar future research can be planned for the affective and psychomotor domains.

The clinical learning environment in anaesthesiology in Kerala---Is it good enough?---A web-based survey

Background and Aims

Evaluation of postgraduate (PG) training is important so that necessary modifications can be made. The quality of anaesthesiology teaching in our country has not been explored. We performed a survey among the anaesthesiology PGs of Kerala to assess their perceptions about their learning environment as well as to look for the deficits in the training program.

Methods

An online web-based survey was conducted. The questionnaire was developed after a detailed validation process and circulated via Google forms. The questionnaire had three parts. First part asked for demographic details. Second part had 22 statements in four domains to evaluate the quality of training, which were to be answered based on a five-point Likert scale. The third part asked for the suggestions of the trainees on changes to be made for the improvement in quality of their training.

Results

The response rate was 64%. The social atmosphere was perceived positively in general by our PGs. Majority of them received feedback on their work and had a regular class schedule. Only 34% of the residents got training in non-technical skills. More tutorials and case discussions were the most common change suggested by the residents. Lack of research training and training in simulation labs were the major lacunae identified.

Conclusion

The clinical learning environment (CLE) was perceived to be of medium to high quality by the anaesthesiology PGs of Kerala. Lack of routine assessments and regular academic sessions were reflected in the responses.

Relationship Between "Simulated Patient Scenarios and Role-Playing" Method and OSCE Performance in Senior Anesthesiology Residents: A Correlation Assessment Study

BACKGROUND

"Simulated-patient scenarios and role-playing" and OSCE are among the many non-traditional education methods with variable results in different clinical settings.

OBJECTIVES

This cross-sectional study was performed to assess the correlation between the results of these two methods in senior anesthesiology residents, with a special focus on four of the six ACGME core competencies.

METHODS

During two years, senior anesthesiology residents were subject to "simulated patient scenario and role-playing" sessions. Two faculty members took the role of the patient and one of the relatives. An objective checklist with 15 items was prepared to be rated by other department faculty members. Meanwhile, an ordered pattern of OSCE was prepared to cover four core competencies that were more related to this academic process (from a total of six core competencies). The mean and standard deviation of the score of each of the 15 items in the checklist were calculated. The correlation between cumulative checklist scoring results and OSCE exam results was assessed. A P value of less than 0.05 was considered significant.

RESULTS

A total of 40 senior anesthesiology residents, with 344 assessments by faculty members in 40 sessions, were enrolled in the study. The questionnaire's Cronbach's alpha reliability was 0.74. No statistically significant disparity was detected between the results of the two assessment methods, while the results of the two assessments had a significant correlation (two-tailed correlation coefficient = 0.886; P value < 0.001).

CONCLUSIONS

There was an objective relationship between the results of "simulated patient scenario and role-playing" strategies and the results of OSCE exams using an observer-based rating method. Thus, they could be used as surrogates in the assessment of core clinical competencies of senior anesthesiology residents.

Effectiveness of simulation based teaching of ventilatory management among non-anaesthesiology residents to manage COVID 19 pandemic - A Quasi experimental cross sectional pilot study

BACKGROUND AND AIMS

Simulation is one of the important learning tools when it comes to skill acquisition and as a supplemental tool for training in high stake situations like COVID-19. The aim of this study is to meet the global requirements of knowledge on ventilatory management, prepare and to evaluate the effectiveness of the teaching module for non-anesthesiology trainees on COVID-19 patients.

METHODS

Quasi experimental cross sectional pilot study was conducted with a sample of twenty-six trainees. A teaching module was prepared and validated which consisted of lectures, audio-video sessions, demonstrations with hands-on training, debriefing, analytical-phase and reflection. Pre and Post evaluations from student t-test and direct observation of procedural skills (DOPS) were used for knowledge and skill assessment respectively and feedback obtained from Likert's score.

RESULTS

Pre- and Post-tests had a mean score of 7.42 ± 2.12 and 14.92 ± 2.9 respectively (P value 0.00001). DOPS included 16 point score, in which 23 trainees (88.4%) met the expectations and above expectations as per training objectives. A five-point Likert's score feedback revealed satisfactory and highly satisfactory scores of 100% (ABG), 96.1% (mechanical ventilation), and 84.6% (ventilation in COVID-19 patients). Overall satisfaction for the workshop among respondents was 100 per cent. Confidences of handling scores were 84.5% (interpreting ABG), 65.3% (maneuvering mechanical ventilation), and 96.15% (intubation in COVID-19 patients).

CONCLUSION

A planned teaching module in ventilation management helps to train non-anaesthesiologists more effectively as a part of COVID-19 preparedness. Simulation with debriefing based training to the medical fraternity is the best alternative in the present pandemic and it will also ensure the safety of health care professionals.

Simulation-based evaluation of anaesthesia residents: optimising resource use in a competency-based assessment framework

Introduction

Simulation training in anaesthesiology bridges the gap between theory and practice by allowing trainees to engage in high-stakes clinical training without jeopardising patient safety. However, implementing simulation-based assessments within an academic programme is highly resource intensive, and the optimal number of scenarios and faculty required for accurate competency-based assessment remains to be determined. Using a generalisability study methodology, we examine the structure of simulation-based assessment in regard to the minimal number of scenarios and faculty assessors required for optimal competency-based assessments.

Methods

Seventeen anaesthesiology residents each performed four simulations which were assessed by two expert raters. Generalisability analysis (G-analysis) was used to estimate the extent of variance attributable to (1) the scenarios, (2) the assessors and (3) the participants. The D-coefficient and the G-coefficient were used to determine accuracy targets and to predict the impact of adjusting the number of scenarios or faculty assessors.

Results

We showed that multivariate G-analysis can be used to estimate the number of simulations and raters required to optimise assessment. In this study, the optimal balance was obtained when four scenarios were assessed by two simulation experts.

Conclusion

Simulation-based assessment is becoming an increasingly important tool for assessing the competency of medical residents in conjunction with other assessment methods. G-analysis can be used to assist in planning for optimal resource use and cost-efficacy.