Lessons for simulation-based education from social psychology.

Effective practice is informed by underlying theoretical models. Better awareness and understanding of such models can enhance reflection by practitioners on their current educational activities and so help drive the cycle of continuing improvement. In this article the author reflects on three ways in which a better understanding of social psychology gave insights into why some practices appeared to be more effective than others and some ways in which future practice could be altered. Social psychology places great emphasis on the importance of the situation in which people find themselves an how this impacts on their subsequent behaviour. The three areas specifically addressed in the article include factors which motivate and drive human activities, especially the importance of self-esteem. Secondly, the relevance of the fundamental attribution error, which looks at our tendency as humans to ascribe personal attributes as the cause of the behaviour of others rather than the influence of external events. The third area to be explored is the role of acquiring scripts or heuristics that can broaden the range of activities than can be performed at a subconscious or intuitive level. For each concept, the author has included a brief illustration of its application to the practice of a simulation educator.

Non-Technical Skills Bingo-a game to facilitate the learning of complex concepts.

Acquiring the concepts of non-technical skills (NTS) beyond a superficial level is a challenge for healthcare professionals and simulation faculty. Current simulation-based approaches to teach NTS are challenged when learners have to master NTS concepts, clinically challenging situations, and simulation as a complex technique. The combination of all three aspects might overwhelm learners. To facilitate the deeper comprehension of NTS concepts, we describe an innovative video-based game, the Non-Technical Skills (NTS) Bingo. Participants get NTS Bingo cards that show five NTS elements each. While observing (non-medical) video clips, they try to find examples for the elements on their cards, typically observable behaviours that match a given element. After the video, participants "defend" their solution in a discussion with the game leader and other players. This discussion and the reflection aim to deepen the processing of the NTS concepts. We provide practical guidance for the conduct of NTS Bingo, including a selection of usable video clips and tips for the facilitated discussion after a clip. We use NTS in anaesthesia as example and provide guidance on how to adapt NTS Bingo to other disciplines. NTS Bingo is based on theoretical considerations on concept learning, which we describe to support the rationale for its conduct.

Review article: the influence of psychology and human factors on education in anesthesiology.

PURPOSE: We look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm. PRINCIPLE FINDINGS: Research in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance. However, existing lessons and practices from industrial or military research may not translate directly into effective strategies for anesthesiologists. Collaborative studies between psychologists and clinicians should continue in order to provide the anesthetic curriculum with an effective body of knowledge for each role of the anesthesiologist. Although individual anesthesiologists have made important contributions in this field, such material has not been formally incorporated into the curricula serving anesthesiologists in the developed world. CONCLUSIONS: There is a gap between the human factors psychologists now know and the human factors anesthesiologists need to know. As that gap closes, anesthesiologists may come to think more like human factor psychologists as well as biomedical scientists.

Literature review: instructional design and pedagogy science in healthcare simulation.

This article is a review of the literature focused on simulation as an educational intervention in healthcare. The authors examined the literature based on four key levels: (1) the validity and reliability of the simulator, (2) the validity and reliability of the performance evaluation tool, (3) the study design, and (4) the translational impact. The authors found that the majority of research literature in healthcare simulation does not address the validity and reliability of the simulator or the performance evaluation tool. However, there are well-designed research studies that address the translation into clinical settings and have positive patient safety outcomes.

Human performance limitations (communication, stress, prospective memory and fatigue).

A key role in anaesthetic practice is gathering and assimilating information from a variety of sources to construct and maintain an accurate mental model of what is happening to the patient, a model that will influence subsequent decisions made by the anaesthetist on the patient's behalf, as part of a larger team. Effective performance of this role requires a set of mental functions that place great demands upon the physiology and psychology of anaesthetists, functions that are vulnerable to a wide range of factors including those affecting team performance and those affecting the anaesthetist specifically. The number of tasks, their complexity, the physical and mental demands of the job, the underlying health and well-being of the anaesthetist and the environment and context within which the team attempt to meet the demands placed on them will influence the outcome of patient care.

When things do not go as expected: scenario life savers.

In this paper we discuss scenario life savers - interventions before and during simulation scenarios that allow to create and use relevant learning opportunities, even if unexpected events happen during the conduction of the scenario. Scenario life savers are needed, when the comprehension or acceptance of the scenario by the participants is at stake, thus compromising learning opportunities. Scenario life savers can principally work by bringing participants back on track of the planned scenario or by adapting the conduction to their actions on the fly. Interventions can be within the logic of the scenario or from the "outside," not being part of the scenario itself. Scenario life savers should be anticipated during the design of scenarios and used carefully during their conduction, aiming to maximize the learning for participants.

The use of an anaesthetic simulator to assess single-use laryngoscopy equipment.

OBJECTIVE: To compare the view at simulated direct laryngoscopy obtained with a standard laryngoscope, with and without a disposable cover and a disposable laryngoscope blade. DESIGN: Randomized non-blinded comparison. SETTING: The high-fidelity human patient simulator at the Scottish Clinical Simulation Centre. PARTICIPANTS: Thirty-two anaesthetists with between 11 months and 25 years of experience. INTERVENTIONS: A randomized comparison of ease of laryngoscopy with each laryngoscope option for simulated easy and difficult laryngoscopy. MAIN OUTCOME MEASURES: The best grade achievable at laryngoscopy (Cormack and Lehane grade) for each laryngoscope, for both easy and difficult laryngoscopy. RESULTS: For the easy setting, 34% (P = 0.001) of anaesthetists graded laryngoscopy more difficult with the covered laryngoscope, and 22% (P = 0.008) with the disposable laryngoscope considered laryngoscopy more difficult than with the standard laryngoscope. For the difficult simulator setting, 69% (P < 0.001) found laryngoscopy more difficult with the covered laryngoscope and 69% (P < 0.001) with the disposable laryngoscope, when compared with the standard laryngoscope. There was no difference between the laryngoscopy grades for the covered and disposable laryngoscope for either easy (P = 0.21) or difficult (P = 0.87) simulation. CONCLUSIONS: Single-use equipment, as presently recommended for tonsillectomy surgery by the UK Department of Health, makes laryngoscopy more difficult for anaesthetists.