RESUMEN
Patient simulators are useful tools for training residents and all levels of medical personnel. Simulator usefulness, in small group sessions, is limited by the costs of training large numbers of people. We present an interrupted methodology designed to involve a large group at a location remote from the simulator. The goal was to enable the remote participants to take part in decision making while under time pressure. Two volunteers were chosen as hands-on participants while eighteen remaining anesthesiology residents observed from a lecture room via a closed circuit audio/video feed. A series of five crises in obstetric anesthesia was presented. After each crisis the simulation was paused and the observers were given three minutes to formulate a differential diagnosis and plan to be carried out. At the end of the session facilitators led a debriefing session with all participants. Surveys completed after the simulation indicated that most residents felt personally involved in the simulation, despite being physically removed from it. Surveys also showed that residents believed they learned more from this format than they would have from a lecture. Residents recalled an average of 3.4 crises two days after the session. This paper presents a model for distance education using a simulator and shows that residents believed remote, interrupted, interactive simulator training is valuable. The interrupted nature and involvement of remotely located peers differentiate this methodology from a passive viewing of a remote session. Further study is warranted to quantify the effectiveness of group and/or distance training with a simulator.
RESUMEN
OBJECTIVE: The medical practitioner is faced with an increasing list of protocols and algorithms related to patient care. These recommendations are often difficult to recall, particularly in stressful emergency situations. Using advanced cardiac life support (ACLS) protocols, we built a computer-based system to exhibit precompiled response plans for medical emergencies. To validate the usefulness of this prompting device, we tested application of two of the nine ACLS algorithms, pulseless ventricular fibrillation/ventricular tachycardia (Vfib/Vtach) and bradycardia, in a simulated operating room (OR) environment. METHODS: The system utilized the software authoring system IconAuthor (Aimtec Inc., Nashua, NH) and a touch-screen monitor (DiamondScan, Microtouch, Methuen, MA). Prior to testing our system, all 39 subjects were given time to familiarize themselves with its operation. Subsequently, all subjects were videotaped while managing a standard simulated anesthetic. During the anesthetic, the subjects were presented with two emergency scenarios, not viewed during the familiarization period. The electrocardiographic (EKG) signals for normal sinus rhythm, ventricular fibrillation, and second-degree heart block were presented. By random selection, the prompter was available to half of the subjects for help with arrhythmia management (experimental group), while to half it was not (control group). RESULTS: A total of 39 subjects completed the exercise. Use of the prompter enabled significantly more subjects to administer correct drugs and dosages during ventricular fibrillation. The correct lidocaine dose was chosen more often by the experimental group than by the control (p = 0.015); similarly MgSO4 was appropriately ordered more often in the experimental group (p = 0.003). During second-degree heart block, atropine was correctly followed with a dopamine infusion (p = 0.004), and epinephrine infusion was ordered for refractory bradycardia (p = 0.002) more often in the experimental than the control group. CONCLUSIONS: These data demonstrate the value of a prompting device at the anesthesia workstation. We foresee the use of such prompters in many areas of medicine.