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Abstract
Airway management, a defined procedural and cognitive skillset embracing routine tracheal intubation and emergency airway rescue, is most often acquired through an apprenticeship model of opportunistic learning during anesthesia or acute care residency training. This training engages a host of modalities to teach and embed skill sets but is generally time- and location-constrained. Virtual reality (VR)-based simulation training offers the potential for reproducible and asynchronous skill acquisition and maintenance, an advantage that may be important with restricted trainee work hours and low frequency but high-risk events. In the absence of a formal curriculum from training bodies-or expert guidance from medical professional societies-local initiatives have filled the VR training void in an unstructured fashion. We undertook a scoping review to explore current VR-based airway management training programs to assess their approach, outcomes, and technologies to discover programming gaps. English-language publications addressing any aspect of VR simulation training for airway management were identified across PubMed, Embase, and Scopus. Relevant articles were used to craft a scoping review conforming to the Scale for quality Assessment of Narrative Review Articles (SANRA) best-practice guidance. Fifteen studies described VR simulation programs to teach airway management skills, including flexible fibreoptic bronchoscopic intubation (n = 10), direct laryngoscopy (n = 2), and emergency cricothyroidotomy (n = 1). All studies were single institution initiatives and all reported different protocols and end points using bespoke applications of commercial technology or homegrown technologic solutions. VR-based simulation for airway management currently occurs outside of a formal curriculum structure, only for specific skill sets, and without a training pathway for educators. Medical educators with simulation training and medical professional societies with content expertise have the opportunity to develop consensus guidelines that inform training curricula as well as specialty technology use.
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Affiliation(s)
- Caoimhe C Duffy
- From the Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Yi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen O'Sullivan
- Department of Anaesthesia, Intensive Care, and Pain, St. James' Hospital, Dublin, Ireland
- Department of Anaesthesia, Trinity College, Dublin, Ireland
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Grandjean C, Casso G, Noirez L, Granell Gil M, Savoldelli GL, Schoettker P. Innovations to Improve Lung Isolation Training for Thoracic Anesthesia: A Narrative Review. J Clin Med 2024; 13:1848. [PMID: 38610613 PMCID: PMC11012997 DOI: 10.3390/jcm13071848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation have opened up exciting new horizons and possibilities. In this narrative review, we examine the latest development of existing training modalities while investigating, in particular, the use of emergent techniques such as virtual reality bronchoscopy simulation, virtual airway endoscopy, or the preoperative 3D printing of airways. The goal of this article is, therefore, to summarize the role of existing and future applications of training models/simulators and virtual reality simulators for training flexible bronchoscopy and lung isolation for thoracic anesthesia.
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Affiliation(s)
- Corinne Grandjean
- Anesthesiology Department, Hospital of Fribourg, 1708 Fribourg, Switzerland;
| | - Gabriele Casso
- Anesthesiology and Intensive Care Department, Istituto Cardiocentro EOC, 6900 Lugano, Switzerland;
| | - Leslie Noirez
- Pneumology Department, University Hospital Lausanne, 1005 Lausanne, Switzerland;
| | - Manuel Granell Gil
- Anesthesiology Department, University of Valencia, 46010 València, Spain;
| | - Georges L. Savoldelli
- Division of Anaesthesia, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland;
| | - Patrick Schoettker
- Anesthesiology Department, University Hospital Lausanne, 1005 Lausanne, Switzerland
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Burnett G, Goldhaber-Fiebert S. The role of simulation training in patients' safety in anaesthesia and perioperative medicine. BJA Educ 2024; 24:7-12. [PMID: 38495746 PMCID: PMC10941098 DOI: 10.1016/j.bjae.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- G.W. Burnett
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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van Haperen M, Kemper TCPM, Hermanides J, Eberl S, Hollmann MW, Breel JS, Preckel B. Does Regular Practice with a "Flexible Bronchoscopy Simulator" Improve Fibreoptic Intubation Skills in Experts and Novices? A Randomized Controlled Study. J Clin Med 2023; 12:5195. [PMID: 37629237 PMCID: PMC10455177 DOI: 10.3390/jcm12165195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The appropriate management of a "difficult airway" remains a challenge for novices and experienced anaesthetists. With the current available airway technologies, e.g., video laryngoscopy, flexible bronchoscopy (fibreoptic intubation (FOI)) for endotracheal intubation is decreasing, likely diminishing caregiver skills. We investigated whether bronchoscopy simulator training improved FOI skills. METHODS 72 volunteers, consisting of anaesthetists, anaesthesia residents, and nurses, performed six exercises on a bronchoscopy simulator. At baseline and after 12 months, the six exercises included one serious game (to train agility), two basic airways, and three difficult airways. After a baseline assessment, subjects were randomly allocated to the intervention group (with) or control group without bronchoscopy simulator training every six weeks for 10 min using a preloaded serious game. The primary outcome was the difference in the time to reach the carina after 12 months, as measured objectively by the simulator. The level of stress and FOI confidence after 12 months were secondary outcomes. RESULTS The control and intervention groups had a similar time to reach the carina in difficult airway cases and the reported stress levels, at baseline and 12 months, showed no difference. In contrast, the intervention group's self-reported confidence in FOI skills improved more. CONCLUSIONS Although participants rated higher in confidence, practicing FOI skills on an airway simulator with an agility game did not increase their performance in simulated challenging airway instances.
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Affiliation(s)
| | | | | | | | | | | | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands; (M.v.H.); (T.C.P.M.K.); (J.H.); (S.E.); (M.W.H.); (J.S.B.)
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Bejani M, Taghizadieh A, Samad‐Soltani T, Asadzadeh A, Rezaei‐Hachesu P. The effects of virtual reality-based bronchoscopy simulator on learning outcomes of medical trainees: A systematic review. Health Sci Rep 2023; 6:e1398. [PMID: 37415680 PMCID: PMC10320745 DOI: 10.1002/hsr2.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Background and Aims Conventional medical training routes of bronchoscopy may decrease patients' comfort and increase procedure-related morbidity. Virtual reality (VR)-based bronchoscopy is a beneficial and safe solution for teaching trainees. The aim of this systematic review was to study the effectiveness of VR-based bronchoscopy simulators on the learning outcomes of medical trainees. Methods Well-known sources (i.e., Scopus, ISI Web of Science, and Medline via PubMed) were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on December, 2021. Peer-reviewed English papers that used VR-based simulation for bronchoscopy training were included. The articles that were studying other technologies, or those that were unrelated to the topic, were excluded. The risk of bias was assessed using the Joanna Briggs Institute checklists for quasi-experimental studies and randomized controlled trials (RCTs). Results Out of 343 studies, 8 of them met our inclusion criteria. An appropriate control group and statistical analysis were the most common and unavoidable sources of bias in included non-RCTs, and lack of blinding in participants was the most common source of bias in RCTs. The included studies evaluated learning outcomes regarding dexterity (N = 5), speed (N = 3), the accuracy of procedures (N = 1), and the need for verbal assistance (N = 1). Based on the results, 100% (5/5) and 66% (2/3) of studies showed that the use of VR-based simulation on the learning outcomes of medical trainees led to improvement in manual ability (i.e., dexterity) and swiftness of execution (i.e., speed in performance), respectively. Additionally, improving the accuracy of subjects' performance, and reducing the need for verbal guidance and physical assistance was reported in studies that evaluated these variables. Conclusion VR bronchoscopy simulator as a training method for teaching medical trainees, especially for novices has the potential to improve medical trainees' performance and reduce complications. Further studies are needed to evaluate the positive effects of VR-based simulation on the learning outcomes of medical trainees.
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Affiliation(s)
- Mahmud Bejani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Ali Taghizadieh
- Department of Emergency Medicine, Tuberculosis and Lung Research Center, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Taha Samad‐Soltani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Afsoon Asadzadeh
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Peyman Rezaei‐Hachesu
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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Cailleau L, Geeraerts T, Minville V, Fourcade O, Fernandez T, Bazin JE, Baxter L, Athanassoglou V, Jefferson H, Sud A, Davies T, Mendonca C, Parotto M, Kurrek M. Is there a benefit for anesthesiologists of adding difficult airway scenarios for learning fiberoptic intubation skills using virtual reality training? A randomized controlled study. PLoS One 2023; 18:e0281016. [PMID: 36706107 PMCID: PMC9882961 DOI: 10.1371/journal.pone.0281016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Fiberoptic intubation for a difficult airway requires significant experience. Traditionally only normal airways were available for high fidelity bronchoscopy simulators. It is not clear if training on difficult airways offers an advantage over training on normal airways. This study investigates the added value of difficult airway scenarios during virtual reality fiberoptic intubation training. A prospective multicentric randomized study was conducted 2019 to 2020, among 86 inexperienced anesthesia residents, fellows and staff. Two groups were compared: Group N (control, n = 43) first trained on a normal airway and Group D (n = 43) first trained on a normal, followed by three difficult airways. All were then tested by comparing their ORSIM® scores on 5 scenarios (1 normal and 4 difficult airways). The final evaluation ORSIM® score for the normal airway testing scenario was significantly higher for group N than group D: median score 76% (IQR 56.5-90) versus 58% (IQR 51.5-69, p = 0.0039), but there was no difference in ORSIM® scores for the difficult intubation testing scenarios. A single exposure to each of 3 different difficult airway scenarios did not lead to better fiberoptic intubation skills on previously unseen difficult airways, when compared to multiple exposures to a normal airway scenario. This finding may be due to the learning curve of approximately 5-10 exposures to a specific airway scenario required to reach proficiency.
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Affiliation(s)
- Loic Cailleau
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Vincent Minville
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Olivier Fourcade
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Thomas Fernandez
- Department of Anesthesia and Intensive Care, University Clermont Auvergne, Clermont Ferrand, France
| | - Jean Etienne Bazin
- Department of Anesthesia and Intensive Care, University Clermont Auvergne, Clermont Ferrand, France
| | - Linden Baxter
- Department of Anesthesia, Oxford University, Oxford, United Kingdom
| | | | - Henry Jefferson
- Department of Anesthesia, Oxford University, Oxford, United Kingdom
| | - Anika Sud
- Department of Anesthesia, Oxford University, Oxford, United Kingdom
| | - Tim Davies
- Department of Anesthesia, University of Warwick and Coventry, Coventry, United Kingdom
| | - Cyprian Mendonca
- Department of Anesthesia, University of Warwick and Coventry, Coventry, United Kingdom
| | - Matteo Parotto
- Department of Anesthesia, University of Toronto, Toronto, Canada
| | - Matt Kurrek
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
- Department of Anesthesia, University of Toronto, Toronto, Canada
- * E-mail:
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Berger-Estilita J, Blülle R, Stricker D, Balmer M, Greif R, Berendonk C. Refreshing medical students' intravenous-cannulation skills: a blinded observer three-arm randomised comparison of mental imagery, part-task trainer simulation and written instructions. BMJ Open 2022; 12:e057201. [PMID: 36691242 PMCID: PMC9171265 DOI: 10.1136/bmjopen-2021-057201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 05/10/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Intravenous cannulation is a core competence in medicine, but is considered challenging to learn. This study investigates the effectiveness of three educational strategies used to refresh the intravenous cannulation skills of first-year medical students: mental imagery, part-task trainer simulation and written instructions. MATERIALS AND METHODS In this single-centre randomised controlled trial, first-year medical students were assigned to one of three different refresher tutorials on intravenous cannulation. Six months after their compulsory 4 hour instructor-led intravenous-cannulation course, each student was randomised to a 6 min self-learning tutorial: a mental imagery audioguide session, hands-on intravenous cannulation on a part-task trainer or reading written instructions.Immediately after the refresher tutorials, trained evaluators who were blinded to the randomised group assessed the students' performance. Each evaluator completed a 15-item standardised checklist in an Objective Structured Clinical Examination (OSCE) station for intravenous cannulation. We performed a descriptive analysis of the data and a one-way analysis of variance. Additionally, we investigated the influence of previous intravenous cannulation experience on the total OSCE score. RESULTS AND DISCUSSION On analysing the 309 students' results, we did not find differences in the total rating of the performance (in percentage) between the three groups at the OSCE station (mental imagery group: 72.0%±17.9%; part-task trainer group: 74.4%±15.6%; written instructions group: 69.9%±16.6%, p=0.158). Multiple linear regression showed a small but statistically significant effect of students' previous intravenous cannulation experience on OSCE performance. With the same outcome, written instructions and mental imagery had a better return on effort, compared with resource-intensive hands-on training with part-task trainers. CONCLUSION A single, short refresher seems to have a limited effect on intravenous-cannulation skills in first-year medical students. Less resource-intensive interventions, such as written instructions or mental imagery, are effective compared with hands-on part-task trainer simulation for refreshing this simple but important skill. TRIAL REGISTRATION NUMBER AEARCTR-0008043.
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Affiliation(s)
- Joana Berger-Estilita
- Department of Anaesthesiology and Pain Medicine, University of Bern, Bern, Switzerland
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rafael Blülle
- Department of Anaesthesiology and Pain Medicine, University of Bern, Bern, Switzerland
| | - Daniel Stricker
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Mathias Balmer
- Bernese Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Feeley AA, Feeley IH, Merghani K, Sheehan E. Use of procedure specific preoperative warm-up during surgical priming improves operative outcomes: A systematic review. Am J Surg 2022; 224:1126-1134. [DOI: 10.1016/j.amjsurg.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/01/2022]
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Abstract
BACKGROUND Rehearsal simulations are patient-specific case- matched tasks performed immediately prior to the actual task, with the objective of improving performance. OBJECTIVE How does rehearsal simulation for antenatal consults impact how residents learn to engage in difficult conversations with families? STUDY DESIGN Residents in the NICU performed case-matched video recorded rehearsal simulations, followed by actual antenatal consults. The purpose of antenatal consults is to prepare parents expecting a complication with their baby before birth. Questionnaires assessed changes in resident confidence and self-assessment of communication skills. Residents were interviewed for qualitative data to explore the overall impact of rehearsal simulation on their learning and performance. RESULTS Thirteen residents participated. Rehearsal simulation improved confidence with a more organized approach of medical content and better communication techniques, allowing for a shift of focus from a checklist approach to building rapport and displaying empathy. CONCLUSIONS While rehearsal simulation did not prepare residents for unexpected parent responses, trainees' increased confidence with medical content organization and communication techniques created space for reflection-in-action and compassionate approaches.
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Affiliation(s)
- Anita Cheng
- Neonatal-Perinatal Medicine, Center for Education Research & Innovation, Western University, Ontario, Canada
| | - Doris Yuen
- Neonatal-Perinatal Medicine, Center for Education Research & Innovation, Western University, Ontario, Canada
| | - Sayra Cristancho
- Department of Surgery and Department of Medical Biophysics, Center for Education Research & Innovation, Western University, Ontario, Canada
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Ormandy D, Kolb B, Jayaram S, Burley O, Kyzas P, Vallance H, Vassiliou L. Difficult airways: a 3D printing study with virtual fibreoptic endoscopy. Br J Oral Maxillofac Surg 2020; 59:e65-e71. [PMID: 33358011 DOI: 10.1016/j.bjoms.2020.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
Head and neck cancer patients present unique airway challenges, and oropharyngeal, laryngeal, and hypopharyngeal tumours considerably distort and narrow the anatomy of the airway. We describe the use of 3D augmented reality software combined with 3D printed models to assess the anatomy of difficult airways and to assist in the formulation of the most optimal airway management strategy in such patients. The reported patients had computed tomograms (CT) of the neck prior to their anaesthetic and surgical management. DICOM files of the respective scans were imported to 3D rendering software (OsiriX, Pixmeo). We constructed volume rendered models for initial assessment of the airway then generated serial surface rendered models to create a virtual endoscopic path of the airway to simulate the fibreoptic approach. To further facilitate the study of difficult airways we have subsequently printed 3D models of those that were most difficult using rapid prototyping. Head and neck tumours significantly distort the airway. Thorough study of the relevant anatomy prior to airway management for operating reasons enhances communication between the surgeon and anaesthetist, and aids selection of the most appropriate intubation approach. In conclusion, this paper highlights a useful and novel pre-assessment strategy that allows a virtual, visual, 3-dimensional assessment of the airway anatomy combined with 3D modelling and 3D printing. This enables the airway specialist, anaesthetist, and head and neck surgeon to anticipate any critical steps and adjust the plan accordingly.
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Affiliation(s)
- D Ormandy
- Department of Anaesthetics, North Manchester General Hospital/ Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
| | - B Kolb
- Department of Anaesthetics, North Manchester General Hospital/ Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
| | - S Jayaram
- Department of ENT, North Manchester General Hospital/Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
| | - O Burley
- Department of OMFS, North Manchester General Hospital/Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
| | - P Kyzas
- Department of OMFS, North Manchester General Hospital/Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
| | - H Vallance
- Department of Anaesthetics, North Manchester General Hospital/ Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
| | - L Vassiliou
- Department of OMFS, North Manchester General Hospital/Pennine Acute Hospitals NHS Trust, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom.
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Weller JM, Naik VN, San Diego RJ. Systematic review and narrative synthesis of competency-based medical education in anaesthesia. Br J Anaesth 2020; 124:748-760. [DOI: 10.1016/j.bja.2019.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/06/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND Surgical educators are increasingly exploring surgical simulation and other nonclinical teaching adjuncts in the education of trainees. The simulators range from purpose-built machines to inexpensive smartphone or tablet-based applications (apps). This study evaluates a free surgery module from one such app, Touch Surgery, in an effort to evaluate its validity and usefulness in training for hand surgery procedures across varied levels of surgical experience. METHODS Participants were divided into 3 cohorts: fellowship-trained hand surgeons, orthopedic surgery residents, and medical students. Participants were trained in the use of the Touch Surgery app. Each participant completed the Carpal Tunnel Release module 3 times, and participants' score was recorded for each trial. Participants also completed a customized Likert survey regarding their opinions on the usefulness and accuracy of the app. Statistical analysis using a 2-tailed t test and analysis of variance was performed to evaluate for performance within and between cohorts. RESULTS All cohorts performed better on average with each subsequent simulation attempt. For all attempts, the experts outperformed the novice and intermediate participants, while the intermediate cohort outperformed the novice cohort. Novice users consistently gave the app better scores for usefulness as a training tool, and demonstrated more willingness to use the product. CONCLUSIONS The study confirms app validity and usefulness by demonstrating that every cohort's simulator performance improved with consecutive use, and participants with higher levels of training performed better. Also, user confidence in this app's veracity and utility increased with lower levels of training experience.
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Affiliation(s)
- Jacob Tulipan
- Thomas Jefferson University,
Philadelphia, PA, USA,Jacob Tulipan, Orthopaedic Surgery, Sidney
Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Room
516 College, Philadelphia, PA 19107-5005, USA.
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Khan R, Scaffidi MA, Grover SC, Gimpaya N, Walsh CM. Simulation in endoscopy: Practical educational strategies to improve learning. World J Gastrointest Endosc 2019; 11:209-218. [PMID: 30918586 PMCID: PMC6425285 DOI: 10.4253/wjge.v11.i3.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
In gastrointestinal endoscopy, simulation-based training can help endoscopists acquire new skills and accelerate the learning curve. Simulation creates an ideal environment for trainees, where they can practice specific skills, perform cases at their own pace, and make mistakes with no risk to patients. Educators also benefit from the use of simulators, as they can structure training according to learner needs and focus solely on the trainee. Not all simulation-based training, however, is effective. To maximize benefits from this instructional modality, educators must be conscious of learners' needs, the potential benefits of training, and associated costs. Simulation should be integrated into training in a manner that is grounded in educational theory and empirical data. In this review, we focus on four best practices in simulation-based education: deliberate practice with mastery learning, feedback and debriefing, contextual learning, and innovative educational strategies. For each topic, we provide definitions, supporting evidence, and practical tips for implementation.
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Affiliation(s)
- Rishad Khan
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London ON N6A 5C1, Canada
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
- Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston ON K7L 3N6, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto ON M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto ON M5G 1X8, Canada
- The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
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Evain JN, Perrot A, Vincent A, Cejka JC, Bauer C, Duclos A, Rimmelé T, Lehot JJ, Lilot M. Team planning discussion and clinical performance: a prospective, randomised, controlled simulation trial. Anaesthesia 2019; 74:488-496. [PMID: 30768684 DOI: 10.1111/anae.14602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
Abstract
Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia and intensive care were randomly allocated to either an intervention or control group before participating in a standardised simulated scenario. Twelve different scenarios were utilised. Groups were stratified by postgraduate year and simulated scenario, and a facilitator was embedded in the scenario. In the intervention group, the pairs had an oral briefing followed by a 4-min planning discussion before starting the simulation. The primary end-point was clinical performance, as rated by two independent blinded assessors on a score of 0-100 using video records and pre-established scenario-specific checklists. Crisis resource management and stress response (cognitive appraisal ratio) were also assessed. Two pairs were excluded for technical reasons. Clinical performance scores were higher in the intervention group; mean (SD) 51 (9) points vs. 46 (9) in the control group, p = 0.039. The planning discussion was also associated with higher crisis resource management scores and lower cognitive appraisal ratios, reflecting a positive response. A 4-min planning discussion before a simulated critical care situation improved clinical team performance and cognitive appraisal ratios. Team planning should be integrated into medical education and clinical practice.
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Affiliation(s)
- J-N Evain
- Department of Anaesthesia and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France
| | - A Perrot
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - A Vincent
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-C Cejka
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Bauer
- Department of Anaesthesia and Intensive Care, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - A Duclos
- Health Services and Performance Research laboratory (EA 7425), Claude Bernard Lyon 1 University, Lyon, France
| | - T Rimmelé
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-J Lehot
- Centre Lyonnais d'Enseignement par la Simulation en Santé, Claude Bernard Lyon 1 University, Lyon, France
| | - M Lilot
- Health Services and Performance Research laboratory (EA 7425), Claude Bernard Lyon 1 University, Lyon, France
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15
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Abstract
PURPOSE OF REVIEW Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. RECENT FINDINGS Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness. SUMMARY Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed.
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16
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Abstract
PURPOSE OF REVIEW In order for the obstetric anesthesiologist to become a true perioperative / peripartum physician, a change in formative programs and certification process in anesthesia are needed. RECENT FINDINGS Anesthesia training programs are migrating to competency based medical education (CBME) worldwide. The traditional model of attending lectures, grand rounds, reading textbooks and journal papers should be complemented by virtual modalities such as massive open online courses or online teaching tools. The gold standard for assessment of procedural skills in anesthesia consists of a combination of global rating scales and previously validated checklists. Behaviors in the perioperative environment not directly related to the use of drugs, equipment or medical expertise are known as anesthesiologist nontechnical skills and trainees must learn and practice these skills; nontechnical skills can determine 50-80% of adverse events in high-risk professions, including medicine. Regular certification programs are also an important component of the new approach in medical education, in some high-income countries, the specialist anesthesiologist is undertaking regular certification but the impact of these programs on overall outcomes is still unknown. SUMMARY The obstetric population is becoming a higher risk population, requiring an obstetric anesthesiologist taking on the role of a perioperative / peripartum physician. It is essential that anesthesia training programs migrate to CBME through simulation-based curriculum that allow the achievement of nontechnical skills and team work competencies. It is also essential that regular certification for specialist anesthesiologists occur throughout their entire career.
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17
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Gotow N, Moritani A, Hayakawa Y, Akutagawa A, Hashimoto H, Kobayakawa T. Effect of a warm-up sample on stabilizing the performance of untrained panelists in time-intensity evaluation. J SENS STUD 2017. [DOI: 10.1111/joss.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Naomi Gotow
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1 Higashi; Tsukuba Ibaraki 305-8566 Japan
| | - Ami Moritani
- Global R&D - Health Care, Kao Corporation, 2-3-1 Bunka, Sumida-ku; Tokyo 131-8501 Japan
| | - Yoshinobu Hayakawa
- Global R&D - Health Care, Kao Corporation, 2-3-1 Bunka, Sumida-ku; Tokyo 131-8501 Japan
| | - Akihito Akutagawa
- Global R&D - Health Care, Kao Corporation, 2-3-1 Bunka, Sumida-ku; Tokyo 131-8501 Japan
| | - Hiroshi Hashimoto
- Global R&D - Health Care, Kao Corporation, 2-3-1 Bunka, Sumida-ku; Tokyo 131-8501 Japan
| | - Tatsu Kobayakawa
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1 Higashi; Tsukuba Ibaraki 305-8566 Japan
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18
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Affiliation(s)
- J M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Specialist Anaesthetist, Auckland City Hospital, Auckland, New Zealand
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19
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Tino Greif R. EAMS corner. Trends in Anaesthesia and Critical Care 2016. [DOI: 10.1016/j.tacc.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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