Best practice & research. Clinical anaesthesiology
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Simulation has become a major player in the medical world. Still way behind other high-risk industries, simulation is being increasingly accepted and finds its ways into many clinical areas. Simulation offers the possibility to train individual skills as well as to evaluate performance, provide group crisis management training or even investigate the safety of installed systems and algorithms without risking patient's life. ⋯ Simulators can be used to improve communication skills and workload distribution, and specifically drill for obstetric-relevant crisis scenarios. However, it remains unclear how well these trainings do transfer into clinical performance and improved patient outcome. Being a relevant cost factor, simulation will have to provide answers to these questions; hence, more research is needed in the future.
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Best Pract Res Clin Anaesthesiol · Mar 2015
ReviewBriefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting.
In this article, we review the debriefing literature and point to the dilemma that although debriefings especially intend to enhance team (rather than individual) learning, it is particularly this team setting that poses risks for debriefing effectiveness (e.g., preference-consistent information sharing, lack of psychological safety inhibiting structured information sharing, ineffective debriefing models). These risks can be managed with a mindful approach with respect to content (e.g., specific learning objectives), structure (e.g., reactions phase, analysis phase, summary phase), attitude (e.g., honesty, curiosity, holding the trainee in positive regard) and setting (e.g., briefings to provide orientation and establish psychological safety). We point to the potential of integrating systemic methods such as circular questions into debriefings, discuss the empirical evidence for debriefing effectiveness and highlight the importance of faculty development.
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Best Pract Res Clin Anaesthesiol · Mar 2015
ReviewBasic concepts for crew resource management and non-technical skills.
In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems.
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Best Pract Res Clin Anaesthesiol · Mar 2015
ReviewFirst of all: Do not harm! Use of simulation for the training of regional anaesthesia techniques: Which skills can be trained without the patient as substitute for a mannequin.
Character of clinical skills training is always influenced by technical improvement and cultural changes. Over the last years, two trends have changed the way of traditional apprenticeship-style training in regional anaesthesia: firstly, the development in ultrasound-guided regional anaesthesia, and secondly, the reduced acceptance of using patients as mannequins for invasive techniques. Against this background, simulation techniques are explored, ranging from simple low-fidelity part-task training models to train skills in needle application, to highly sophisticated virtual reality models – the full range is covered. ⋯ The task in clinical practice will be in choosing the right level of sophistication for the desired approach and trainee level. However, the transfer of simulated skills to clinical practice has not been evaluated. It has to be proven whether simulation-trained skills could, as a last consequence, reduce the risk to patients.
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Emergency medicine has been a stronghold of simulation-based training ever since high-fidelity simulators became available. The preclinical setting differs remarkably from any in-hospital environment in both available technology and resources, and thus stress levels of the health-care professionals involved in patient care – ideal factors for the simulation-based teaching approach. This review reports on the current status of the method for teaching preclinical scenarios from an educational and practical perspective. Particular attention is given to contents, formats, and evaluation of success.