Simulation Training for Residents
Simulation experiences are utilized to inform and enhance resident education in a safe and controlled environment. Sessions provide interactive, interdisciplinary, and immersive simulation-based learning opportunities centered on clinical skill acquisition and crisis resource management, including practice in assimilating data, exercising judgment, and improving teamwork, leadership, and interpersonal communication methods. Simulation experiences correspond with residents’ progression of skills and knowledge acquisition throughout their four years of training. Debriefing sessions follow all simulation learning experiences and serve as a vehicle for constructive discussion about the learning experience and exploration of individual viewpoints for patient care improvement.
CA-1 First Month Orientation
All incoming residents participate in an intensive two day orientation session using the human patient simulator (HPS). Residents are introduced to the HPS and are shown what the simulator is capable of doing both physically and on the patient monitor which is linked to the simulator patient. Basic clinical scenarios are also presented to provide an orientation to the operating room setting and warm up for more advanced scenarios.
First year residents participate in a fun, half-day Anesthesia Olympics experience during their first month of training. Participants rotate through six learning stations to demonstrate their current knowledge and skills in preoperative evaluation, anesthesia machine and operating room setup, IV induction, intraoperative crisis, post-anesthesia care unit handoff, and anesthesia induction. By early evaluation and correction (if needed), participants learn how to correctly accomplish these recurrent tasks from the beginning of training.
In each of the CA-1 through CA-3 years, residents will be scheduled time to participate in simulation training using the HPS. Various intra-operative clinical experiences will be simulated which serve to improve and assess medical knowledge, interpersonal and communication skills, professionalism, systems-systems-based practice, and/or practice-based learning and improvement. Residents will be scheduled simulation time on a quarterly basis in order to complete the simulation core-curriculum, which consists of 12 designated simulation sessions. Clinical scenarios cover each subspecialty as well as emergent/uncommon events. Simulations specific to resident training include scenarios such as monitored anesthesia care in which the physiological response to commonly used sedative drugs (midazolam, fentanyl, propofol) can be evaluated in real time, to more difficult situations in which the consciously sedated patient experiences extremes of blood pressure, hypoxia, hypercarbia, dysrythmias, and anaphylaxis.
Approximately two days per month are built into the resident didactic series to accomplish simulation sessions dedicated to various subspecialties. High fidelity and task simulators are utilized to train residents on various techniques which include the normal and difficult airway, central and arterial line placement, ACLS mega code, invasive monitors, ultrasound guided regional blocks (including spinal and epidural), lung isolation techniques, and double lumen tube placement.
The opportunity to practice various anesthesiology procedural skills is available in the Anesthesia Learning Lab (ALL) within the anesthesiology department offices, room N232. Various task trainers are housed within the learning lab and are available to anesthesiology residents 24/7. In addition to open hours, residents have regularly scheduled simulation sessions by subspecialty faculty members. Click here to see to see the various task simulators housed in the ALL.
Transesophageal Echocardiogram (TEE)
The HeartWorks TEE Simulator is always available to anesthesiology residents in the Anesthesia Learning Lab (ALL). Residents are introduced to the TEE simulator in their CA-1 year during regularly scheduled subspecialty simulation sessions. Residents gain further TEE experience in their CA-2 and CA-3 years on their CT-TEE and TEE rotations. The TEE simulator is used, in addition to operating room experience, to enhance the resident's ability to obtain the 20 major ASE/ACC TEE views and identify the major pathology. In addition to frequent TEE training with CT anesthesiology faculty, a weekly TEE simulator session is scheduled in collaboration with cardiology faculty, residents, and fellows.
Crisis Resource Management
Residents are trained on crisis resource management using simulation training. Specific protocols and algorithms, such as the difficult airway algorithm, and components of effective crisis resource management are introduced and reinforced. Simulation improves the learner’s problem recognition, proper diagnosis, and the best treatment. It is also used to alert residents to the anatomy of critical events, common errors, and ways to avoid potentially harmful errors.
At least once per year, anesthesiology residents and faculty, in conjunction with residents and faculty from other specialties, nurses and others, participate in an interdisciplinary simulation experience. The ability to interact with all health care professionals at all levels in a clinical situation is the focus of this simulation training experience. Crisis resource management was the topic of this year's interdisciplinary grand rounds presentation.
During the CA-3 year, residents can elect to spend up to six months of elective time conducting research. Residents can choose simulation to be a focus of a medical education research project. Recent resident research projects include:
- Patient simulation for training in crisis resource management of regional anesthesia complications
- Software-based simulation for resident physician training in the management of a temporary pacemaker
- Fourth-year physiology
- The obstructive physician