Anesthesia Alert: The Value of Simulation Training

During my anesthesia training, instructors would often compare the complexities of administering sedation to learning how to fly a plane. Anesthesia providers, like their pilot counterparts, undergo rigorous training. They must complete a minimum number of clinical hours before sitting behind the controls of an anesthesia machine. Even after flying solo in surgery, they still log numerous hours learning how to improve patient care and manage potentially life-threatening situations.

Despite this comprehensive on-the-job training, anesthesia providers must constantly run through response protocols for infrequently occurring clinical scenarios that could end in dire consequences — unsuccessful intubations or ventilations, airway fires, the sudden onset of malignant hyperthermia and the patient coding during surgery —  if providers are unprepared to handle them quickly and effectively. 

Enter simulation training. It's used to mimic real-life events to improve patient safety and quality of care by ensuring anesthesia providers are prepared to handle whatever high-pressure, high-consequence situation they encounter.

Simulation training allows learning to take place in an environment where patient harm cannot occur. Some simulations focus on clinical tasks and skills, including performing an anesthesia machine safety check or practicing standardized intubation techniques on an airway trainer. Other scenarios cover more advanced and complex skills that are essential to master, such as performing a correct induction sequence or troubleshooting the intraoperative care of a patient with poor hemodynamics.

Some simulations are aimed at improving provider-to-provider communication skills to decrease the likelihood of a medical error occurring or miscommunication that can result in patient harm.

The overall simulation experience, specifically the debriefing portion, allows for participants to observe and reflect on their actions and thought processes within a safe space. Overall, simulation creates opportunities for experiential learning that further enhance higher order cognitive skills such as application and analysis.

Simulation training comes in a variety of forms and can be held in a variety of locations. It can take place at a dedicated center, such as a simulation lab equipped with anesthesia machines, monitors and patient mannequins. It can also occur "in situ" at an employee's location. By conducting simulations in situ, participants can better understand their roles as they relate to their current work environment. Such simulations can help unmask potential hazards, such as not being able to locate necessary medications and equipment, or realizing communication was not clear or complete.

Anesthesia-based simulation is also offered at a variety of educational conferences. These professional development opportunities allow participants to further their learning, practice new skills and techniques and review current guidelines in anesthesia practice. Examples of simulation training in conferences range from placing ultrasound-guided regional blocks, practicing intubation techniques with the latest airway management technology, crisis resource management and mock codes. 

In the academic arena, simulation can be used as a method for students to decrease personal anxiety while gaining valuable experience prior to entering the operating room. As a student, I recall participating in a variety of simulation activities. Simulations involving some of the most basic tasks — such as room setup, anesthesia machine checks and patient positioning — have had the greatest impact on my practice.

Simulation training comes in a variety of forms and can be held in a variety of locations.

During the patient positioning simulation that took place during my education, each student had the opportunity to lay on an operating room table while being placed in common surgical positions. I was able to experience firsthand what would happen if a patient under general anesthesia was positioned incorrectly and the potential nerve damage that could result. Having my arms stretched out on arm boards at incorrect angles helped reinforce the didactic teaching I received and made me realize the importance of applying it to clinical practice.

Now, as a simulation educator, I have designed a variety of simulations aimed at increasing patient safety. One involves a pediatric patient presenting with a postoperative tonsillectomy bleed. In this timed scenario, the participants must be able to work together and utilize the resources in the operating room to achieve a positive outcome. While progressing through the American Society of Anesthesiologists' Difficult Airway Algorithm, participants are required to use their critical thinking skills, manage a compromised pediatric airway, prioritize and delegate tasks and keep the patient hemodynamically stable.

This is not easily accomplished. It's one thing to read and memorize an algorithm and quite another to progress through it when confronted with an unstable patient.

Simulation training is an art form. It provides a unique opportunity to marry didactic knowledge with clinical skill and acumen in a judgment-free zone. It allows for the educator to enhance the curriculum beyond words written on a page. It allows the learner to improve their affective, cognitive and clinical skills. Ultimately, it helps to develop competent and safe anesthesia providers. OSM