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Practical Updates in Anesthesiology. Dr. Mark Wigginton MB,BS FRCA. The Fall & Rise of Simulation. Anatomical models. Anatomical stone sculpture from 24,000 years BC Egyptian Mayan 18 th & 19 th century memento mori Song dynasty – Wang Wei-Ye (987-1067).
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Practical Updates in Anesthesiology Dr. Mark Wigginton MB,BS FRCA
Anatomical models • Anatomical stone sculpture from 24,000 years BC • Egyptian • Mayan • 18th & 19th century memento mori • Song dynasty – Wang Wei-Ye (987-1067)
Interactive models • 1739 British maternity hospital opens with a promise, • “all the inconveniences which might otherwise happen to women from pupils practising too early on real objects will be entirely prevented: for by this method and contrivance each pupil will become in a great measure proficient in his business before he attempts a real delivery.” • Giovanni Antonio Galli • Dr. Ozenne • Marguerite Le Boursier du Coudray
‘The Machine’ – Musée Flaubert et d'Histoire de la Médecine, Rouen
Facilities for teaching Obstetrics in US Hospitals - 1909 • Southwestern University Medical College, Texas • “in the corner of one [lecture room] is an abused manikin.” • Georgia College of Eclectic Medicine & Surgery, Georgia • “limited to a tattered manikin.”
Commenting on medical training institutions • Of the four institutions in the state of Texas only one was felt, “capable of maintaining a medical school whose graduates deserve the right to practice among its inhabitants.” • “Those who deal with medical education in Tennessee are therefore making the worst, not the best, of their limited possibilities.” • Portland and Salem, Oregon, “Neither of these schools has either resources or ideals; there is no justification for their existence.” • University of Michigan Department of Medicine & Surgery, “There is no question that if the entire state university were at Detroit, the medical department would be better off.” • “A faculty of distinction, with a hospital well equipped for the care of the sick, and for teaching and research, can successfully overcome the most serious difficulties of the situation.”
Simulation manufacturers • Laerdal • CAE Healthcare (formerly METI) • Gaumard • Simulab • Improvised & local adaptations
Current Simulation Technology for Anesthesia • Task trainers • Low fidelity mannequins • High fidelity mannequins
Sim Man 3G • Quality CPR feedback • Convulsions • Bleeding wounds • Wireless monitor • Secretions • Drug and event recognition • Eye signs • Vascular access • Chest decompression and chest drain • Airway complications
Train the trainers • Being an expert in a field of medicine does not qualify to teach simulation in that field • Ensure consistency of teaching standards • Ensure maximum use from simulators • Ensure educational value of course/scenario design • Not all train the trainers are equal • Insufficient trained trainers to support the amount of simulation based medical education
The Australian Model • November 2010 – MONASH University report, “Faculty development is a critical issue in effective simulation based education.” • Health Workforce Australia (SLE Program) • Phase 1: Australian Simulation Education & Technical training (AusSETT) • Phase 2: National Health Education & Training in Simulation (NHET-Sim)
Proof of benefit The Future Standardise train the trainers National strategy Public interest Share ideas (for free) Standardise courses
References • Owen H. Early Use of Simulation in Medical Education. Simulation in Healthcare 2012; 7(2): 102-116 • Cooper J., Taqueti V. A brief history of the development of mannequin simulators for clinical education and training. QualSaf Health Care 2004; 13(Suppl 1): i11-i18 • Daniels K., Parness A. Development and Use of Mechanical Devices for Simulation of Seizure and Hemorrhage in Obstetrical Team Training Simulation in Healthcare 2008; 3: 42-46 • McGaghie W., Draycott T., Dunn W., Lopez C. Evaluating the Impact of Simulation on Translational Patient Outcomes Simulation in Healthcare Vol. 6, No. 7, August 2011 Supplement S42-47 • McGaghie W., Issenberg S., Cohen E., Barsuk J., Wayne D. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011;86:706 –711. • Issenberg S., McGaghie W., Hart I., et al. Simulation technology for health care professional skills training and assessment. JAMA 1999; 282:861– 866 • Draycott TJ, Sibanda T, Owen L, et al. Does training in obstetric emergencies improve neonatal outcome? BJOG 2006;113:177–182. • Draycott TJ, Crofts JF, Ash JP, et al. Improving neonatal outcome through practical shoulder dystocia training. ObstetGynecol2008;112:14–20. • Howard S, Gaba D, Fish K, Yang G, Sarnquist F. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med 1992; 63:763–70 • Denson J., Abrahamson S. A Computer-controlled Patient Simulator. JAMA 1969;208:504-8 • Flexner A. Medical Education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching. New York,NY;1910 Available at http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.pdf (last accessed 01/01/2014) • Gelbert NR. The King’s Midwife: A History and Mystery of Madame du Coudray. Berkley, CA: University California Press; 1998 • Porter R. Blood and Guts: A Short History of Medicine. London: The Penguin Press; 2002 • Russell KF. Ivory Anatomical Manikins. Med Hist 1972;16:131-142 • https://www.hwa.gov.au/sites/uploads/simulated-learning-environments-medical-curriculum-report-201108.pdf