Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Comparative Study
Motion capture measures variability in laryngoscopic movement during endotracheal intubation: a preliminary report.
Success rates with emergent endotracheal intubation (ETI) improve with increasing provider experience. Few objective metrics exist to quantify differences in ETI technique between providers of various skill levels. We tested the feasibility of using motion capture videography to quantify variability in the motions of the left hand and the laryngoscope in providers with various experience. ⋯ Motion analysis can detect interprovider differences in hand and laryngoscope movements during ETI, which may be related to provider experience. This technology has potential to objectively measure training and skill in ETI.
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Increased patient awareness, duty hour restrictions, escalating costs, and time constraints in the operating room have revolutionized surgery education. Although simulation and skills laboratories are emerging as promising alternatives for skills training, their integration into graduate surgical education is inconsistent, erratic, and often on a voluntary basis. We hypothesize that, by implementing the American College of Surgeons/Association of Program Directors in Surgery Surgical Skills Curriculum in a structured, inanimate setting, we can address some of these concerns. ⋯ The American College of Surgeons/Association of Program Directors in Surgery National Surgical Skills Curriculum can be implemented in its totality as a 4-week consecutive surgical simulation rotation in an inanimate setting, leading to global enhancement of junior surgical residents' technical skills and contributing to attainment of Accreditation Council for Graduate Medical Education core competency.
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Training for direct laryngoscopy relies heavily on practice with patients. The necessity for human practice might be supplanted to some extent by an intubation mannequin with accurate airway anatomy, a realistic "feel" during laryngoscopy, the capacity to model many patient configurations, and a means to provide feedback to trainees and instructors. The goals of this project were (1) to build and evaluate an airway simulator with realistic dimensions and haptic sensation that could undergo a range of adjustments in several features that affect laryngoscopy difficulty and (2) to develop a system for displaying information on laryngoscopy force and motion in real time. ⋯ The model incorporates novel features that could aid in developing mastery of the laryngoscopy procedure. Further work is needed to investigate how adjustability and feedback impact the value of laryngoscopy practice on mannequins.
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Organizational behavior and management fields have long realized the importance of teamwork and team-building skills, but only recently has health care training focused on these critical elements. Communication styles and strategies are a common focus of team training but have not yet been consistently applied to medicine. We sought to determine whether such communication strategies, specifically "advocacy" and "inquiry," were used de novo by medical professionals in a simulation-based teamwork and crisis resource management course. Explicit expression of a jointly managed clinical plan between providers, a strategy shown to improve patient safety, was also evaluated. ⋯ Anesthesiologists advocated more frequently than obstetricians, while obstetricians inquired and advocated in more balanced proportions. However, fewer than half of the teams explicitly agreed on a joint plan. Increasing awareness of communication styles, and possibly incorporating these skills into medical training, may help teams arrive more efficiently at jointly managed clinical plans in crisis situations.
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We propose an intraosseous (IO) procedure scale for evaluating the insertion process during simulation. A 12-item scale for assessing the performance of IO insertion into the proximal tibia reproduces all the steps of a manual procedure. ⋯ The application of this scale to procedures yielded higher scores for successful than for unsuccessful procedures (P < 10), a 93.5% success rate, and a mean placement time of 2 minutes 23 seconds. Although designed for a manual insertion of an IO needle during simulation, this scale may be also suitable for use in clinical settings.