Practical Updates in Anesthesiology

1. Practical Updates in Anesthesiology Dr. Mark Wigginton MB,BS FRCA

5. The Fall & Rise of Simulation

6. Anatomical models • Anatomical stone sculpture from 24,000 years BC • Egyptian • Mayan • 18th & 19th century memento mori • Song dynasty – Wang Wei-Ye (987-1067)

7. De HumaniCorporisFabricaLibri Septum by Andrea Vesalio 1543

8. 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

9. AngéliqueMargeurite Le Boursier du Coudray1714 -1789

10. ‘The Machine’ – Musée Flaubert et d'Histoire de la Médecine, Rouen

11. The Flexner Report

12. 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.”

13. 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.”

14. Sim One

15. Laerdal

17. Simulation manufacturers • Laerdal • CAE Healthcare (formerly METI) • Gaumard • Simulab • Improvised & local adaptations

18. Current Simulation Technology for Anesthesia • Task trainers • Low fidelity mannequins • High fidelity mannequins

19. Blue Phantom

20. Pediatric HAL

21. 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

22. Human Patient Simulator

23. 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

24. International Societies

25. 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)

26. Proof of benefit The Future Standardise train the trainers National strategy Public interest Share ideas (for free) Standardise courses

27. 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