orienting residents to pediatric anesthesia using in...

• To create an interactive, hands-on orientation to prepare residents new to

the pediatric anesthesia rotation

• Increase learner preparedness, reduce stress levels

• Increase fund of knowledge

Abstract

Orienting residents to pediatric anesthesia using

in-situ simulation and skills training

Christine L. Mai, M.D., MHPE1, Brandon Minzer, M.D.1, David August, M.D.1

1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, United States

Results

Objectives

Conclusions

Introduction

References

9th International Pediatric Simulation Symposium and Workshops 2017

1-3 June, Boston, MA, USA

Methods

Subspecialty rotations for anesthesia residents often have unique

demands that make orienting to a given field challenging. Orienting residents

to pediatric anesthesia is no exception. While orientations to subspecialty

rotations in anesthesiology residency programs are not uncommon, many

programs utilize electronic content (e.g. PowerPoint) that may hinder

learning.1 As an alternative to computer-based content, simulation programs

are beneficial in teaching both technical- and non-technical skills to

anesthesia residents; however, there is limited data exploring in-situ

simulation as an orientation tool for residents beginning subspecialty

rotations.2-6 We describe the development and implementation of an

immersive curriculum that combines procedural skills with high-fidelity

simulation in a constructive-deconstructive format to orient residents to the

nuances of pediatric anesthesia and to teach about common intraoperative

events.

Anesthesiology residents new to the pediatric anesthesia rotation

participated in our orientation on the first day of their rotation. The orientation

aimed to: (1) increase preparedness, (2) reduce trainee’s anxiety by building

perceived confidence early in the rotation, and (3) strengthen fund of

knowledge. The 2-hour curriculum focused on common procedures (i.e.

preparing for a case, managing an infant airway, intravenous placement, and

caudal anesthesia) and frequently encountered perioperative management

issues (i.e. anxious parent interview, parent-present induction, and an airway

emergency).

We developed a survey to assess the orientation’s efficacy. Residents

were asked to rate their feelings of preparedness using Likert-scales. The

surveys were administered before and immediately after the orientation, as

well as 1-month subsequently.

Twenty-seven residents participated in the orientation with approximately

equal number of males and females. Two residents were excluded due to

incomplete data collection. Cronbach’s alpha for the three time-points ranged

from 0.90-0.93 indicating the items had strong internal consistency. Repeated

measures ANOVA detected a positive linear trend, F(1,24)=108.12, p<0.001,

η2=0.82. Pairwise comparisons using the Bonferroni technique revealed a

statistically significant increase in confidence at each subsequent time-point.

Subspecialty rotations often place anesthesia residents in potentially

difficult and stressful situations. Orientation for such rotations may be a critical

opportunity to improve resident experience and knowledge, as well as

enhance patient care. We created an orientation using in-situ simulation and

skills training to help prepare residents for their pediatric anesthesia rotation.

Our data illustrates that such an approach may be useful in learning both

technical skills and subject specific content for a pediatric anesthesia

subspecialty rotation.

1. Bartsch RA, et al.. Effectiveness of PowerPoint presentations in lectures. Comput

Educ 2003;41:77-86

2. Gaba DM, et al. Simulated anaesthetic emergencies. Br J Anaesth. 1997;79:689-

90.

3. Park CS, et al. Acquisition of critical intraoperative event management skills in

novice anesthesiology residents by using high-fidelity simulation-based training.

Anesthesiology. 2010;112:202-11.

4.Castanelli DJ. The rise of simulation in technical skills teaching and the implications

for training novices in anaesthesia. Anaesth Intensive Care. 2009;37:903-10.

5. Fehr JJ, et al. Simulation-based Assessment of Pediatric Anesthesia Skills.

Anesthesiology 2011;15(6):1308-15.

6. Steadman RH, et al. Simulation-based training is superior to problem-based

learning for the acquisition of critical assessment and management skills. Critical

Care Medicine. 2006;34(1):151-57.

OLD ORIENTATION NEW ORIENTATION

• Lecture-based,

PowerPoint

presentation

• In an office

• One hour

• Skills training and high

fidelity simulation

• In-situ (operating room)

• Two hours

Introduction: Pediatric anesthesia training poses significant challenges for

faculty and trainees new to the rotation.

Methods: We developed a curriculum that combines procedural skills with

high-fidelity simulation in a constructive-deconstructive format to orient

residents to the nuances of pediatric anesthesia and to teach about common

intraoperative events.

Results: Anesthesia residents reported feeling more prepared and had an

increased perception of confidence after the orientation.

Conclusion: Anesthesia subspecialty rotation orientation utilizing simulation

may be a critical opportunity to improve resident experience and knowledge.

Figure. 1. Residents’ perception of confidence before (Time “0 hr”), immediately after (Time “2 hr”),

and 1-month post-orientation (Time “1-month”)

Figure 2. Residents’ report of how prepared they feel about performing pediatric anesthesia skills at

Time “0hr,” immediately after orientation “Time 2hr,” and 1-month post-orientation “Time 1-month”

Skills

1) Preop evaluation

2) Calling attending regarding case

3) Develop anesthesia plan

4) Finding the pediatric ORs

5) Setting up the OR

6) Preop/consent with parent

7) Starting pediatric IV

8) Placing pediatric monitors

9) Mask inhalation induction

10) Working with parent during induction

11) Choosing correct drug and dose for

induction

12) Successfully perform laryngoscopy

13) Successfully intubating patients

14) Handling intraop complications

15) Handling postop complications

Lik

ert

-sca

le o

f re

sid

en

ts’ fe

elin

g o

f p

rep

are

dn

ess

Not at all

Somewhat

Moderately

Very

Extremely

Skills