orienting residents to pediatric anesthesia using in...
TRANSCRIPT
• 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