Anesthesia Management: Subdural Hemorrhage and Difficult Airway: A Flat-Screen Simulation and Interactive Debriefing
|7891||January 14, 2010||1|
Anesthesiology residents, who have previously been taught to use a screen-based anesthesia simulator (Anesoft Anesthesia Simulator), are instructed to manage a simulated case of a patient with a subdural hemorrhage and a difficult airway. Learners work individually and anonymously. Once the simulation has been completed, the residents are debriefed. The debriefing consists of a PowerPoint presentation which includes a number of clinical management decisions. The learners are asked to respond to the management questions using an Audience Response System (Turning Point). The anonymous responses are shared with the group and then the instructor discusses the correct, and incorrect, answers.
The educational philosophy is based on experiential learning. First the learner is stressed to make management decisions in the simulation. Then the learner again has to make specific decisions, and the learner's response is compared to that of other members of the audience, and finally the learner gets the expert answer. Because the experience is anonymous, learner embarrassment is minimized. This format can be scaled up to any class size. This material is designed primarily for formative assessment but may be used for summative assessment as part of an OSCE.
Pott L, Budde A. Anesthesia Management: Subdural Hemorrhage and Difficult Airway: A Flat-Screen Simulation and Interactive Debriefing. MedEdPORTAL Publications; 2010. Available from: https://www.mededportal.org/publication/7891 http://dx.doi.org/10.15766/mep_2374-8265.7891
- To be able to demonstrate the ability to develop an adequate anesthetic management plan for a patient with a subdural hematoma.
- To demonstrate the ability to develop an adequate anesthetic management plan for a patient with a full stomach and a potentially difficult intubation.
- Anesthesia Management, Airway Management, Difficult Intubation, Subdural Hematoma (MeSH), Traumatic Brain Injuries (MeSH)
Knowledge for Practice
Practice-based Learning & Improvement
Evaluation of Clinical Performance
Problem-based Learning (PBL)
- Clinical Skills/Doctoring
- Medical Student
Professional School Post-Graduate Training
Authors & Co-Authors
Leonard Pott, MBBCh FCA(SA)
Pennsylvania State University College of Medicine
Arne Budde, MD
Penn State Hershey Medical Center
Effectiveness and Significance
This simulation has been used repeatedly for residents in the Department of Anesthesiology, Penn State Hershey Medical Center, with very good satisfaction scores (data available). No formal assessment of knowledge retention, or knowledge application, has been performed. This simulation was presented as a Simulation Workshop at the World Congress of Anesthesiologists, Cape Town, South Africa. March 2008. The significance of this submission is that it includes not only the simulation, but also a structured debriefing. Advantages of using a screen-based simulation over using a manikin simulation include: - The embarrassment factor for the learner is avoided. - The technique is equally effective for small and large class sizes. - The capital and maintenance costs of the simulation are low compared to manikin-based simulation. - Only one faculty is required to provide a simulation for the class. The authors hope that other teachers will be able to use this model of instruction effectively, and will prepare different debriefings to share.
Special Implementation Guidelines or Requirements
Equipment required: Anesoft Anesthesia Simulator program (Anesoft Corporation, 18606 NW Cervinia Court, Issaquah, WA 98027). This is a screen-based anesthesia simulator which can be easily loaded onto any personal computer. Turning Point Audience Response System. This audience response system integrates seamlessly with PowerPoint, and can generate various reports. A personal computer, loaded with the Anesoft simulator, for each learner. (Can be the learner's private computer) Guidelines: The simulation presenter must be familiar with the Anesoft Anesthesia Simulator, and the Turning Point system.
These programs are not discussed as part of this submission. Residents must get the opportunity to become familiar with the program. If they have never used this simulation program previously, first demonstrate a routine case with no complications to the audience, using a projector to show your computer screen. Allow the audience to do a similar case alone, and only attempt to do the instructional simulation when the learners are completely comfortable with the simulator. Normally about 30 minutes is required for instruction, and about 20 minutes to do the case. The debriefing typically takes about 30 - 45 minutes. Turning Point creates a report of the session which must be saved, which is important, especially for capturing learner feedback and assessment of the simulation session.
We do not feel that it is useful to capture either the simulation data or the debriefing responses in any way that can be linked to the learner. While important and useful for educational research, the identifiable data capture significantly inhibits the learner experience (data from learner feedback).
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Contains materials or information owned by other parties
Figures from published textbooks or journal articles. All referenced in the text of the PowerPoint presentation.