simulation in anaesthesia at the royal adelaide hospital dr graham lowry fanzca
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Simulation in Anaesthesiaat the Royal Adelaide Hospital
Dr Graham Lowry FANZCA
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The Royal Adelaide Hospital Adult Tertiary Teaching Hospital
∞ Affiliated with the University of Adelaide
∞ 680 beds
∞ 23 operating theatres
∞ 24 ICU / 10 HDU/ICU beds
Major trauma referral centre for Sth Australia
∞ Receives 800 retrievals/year
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Department of Anaesthesia
Branch of Critical CareAnaesthesia/Pain/Hyperbaric medicine52 FTE Consultants32 Registrars
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Simulation Unit Operational since 2003
Teaching/education role
∞ Interns
∞ Registrars/trainees
∞ Consultant anaesthetists
∞ Technical and non-technical skills
Relatively low budget
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Specialty of Anaesthesia Five years of postgraduate training
∞ Major focus of training on developing technical skills
Conflict of decreased working hours versus need for clinical experience
∞ Aging population
∞ More complex surgery
Increased emphasis from ANZCA for training in non-technical skills.
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Why Consultant Anaesthetists?Historically, a lack of training in this areaOften seen as leaders during a crisis in theatre BUT:∞No leadership training∞Often poor followers
Crisis Resource Management training is not mandatory
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The Scenarios Clearly defined goals important
Simple clinical scenarios
∞ Diagnostic uncertainty useful for teaching human factors
∞ Team dynamics create complexity
∞ Level of fidelity always a challenge
Self reflection and evaluation important learning component
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Challenges……1 Changing the culture
Stressful for
∞ for participants
∞ facilitators
Labour intensive
∞ maintaining service commitment versus patient safety and quality of care.
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Challenges……2
Availability of relevant, validated outcome measures.
Adequate funding and resource allocationManaging participants’ expectations and comfort
levels
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Advantages ……1
Allows training/experience in rare (but catastrophic) events
Breaks down the “silos”Work as a team, train as a team even if the “team”
is constantly changing
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Advantages ……2
Training/practicing in contextIssues of access to facilitiesMoving beyond the operating theatre…