Simulation-based medical education in Thailand: a cross-sectional online national survey.

BACKGROUND: Simulation-Based Medical Education (SBME) is a teaching method commonly used in undergraduate medical education. Although Thai medical schools have developed a system that incorporates SBME, various aspects of that system require improvement. We surveyed medical school administrators, instructors, and students about SBME in their institutions and the obstacles involved in its implementation, as well as their experiences, expectations, and attitudes regarding the current system. METHODS: We conducted a cross-sectional online survey between August 2019 and July 2020 among administrators, instructors, and 6th-year medical students. A structured questionnaire was developed and distributed to volunteers as an online survey. We recorded details about the SBME system as well as participant characteristics, obstacles, experiences, expectations, and attitudes. We used descriptive statistics as appropriate. RESULTS: We received responses from 15 (68.2%) administrators, 186 instructors, and 371 (13.7%) sixth-year medical students. SBME was commonly used in teaching and evaluation but less so in research. It was mainly used to improve psychomotor tasks, knowledge, patient care, and communication skills. The expected outcomes were improvements in students' performance, knowledge, and practice. The clinical courses were longer and had fewer participants than the pre-clinical courses. Obstacles encountered included shortages of faculty and simulators, time and space limitations, inadequate faculty training, and insufficient financial support. The administrators surveyed had positive attitudes toward SBME. Medical students reported having experience with SBME and strongly agreed that it was beneficial; however, they expected fewer students per class and more learning time to be devoted to these methods. CONCLUSIONS: SBME in Thailand is focused on teaching and assessment. The system could be improved through better-trained faculty, greater available space, more simulators, and sufficient funding. There were also some aspects that failed to meet students' expectations and need to be addressed. However, participants expressed positive attitudes toward SBME. TRIAL REGISTRATION: TCTR20210524003 (Thai Clinical Trials Registry).

Anesthetic Techniques and Incidence of Complications in Fetoscopic Surgery.

BACKGROUND: Nowadays, fetoscopic surgery has been accepted to be a procedure to correct numerous congenital anomalies. This operation can be successfully done under general, regional or local anesthesia with sedation. Incidence of complications from anesthesia in fetoscopic surgery has not been reported in Thailand. OBJECTIVE: To describe anesthetic techniques and incidence of complications in fetoscopic surgery. MATERIAL AND METHOD: Data of 152 pregnant women undergoing fetoscopic surgery in a single university hospital was retrospectively chart reviewed from June 2005 to November 2015. Patient characteristics, choices of anesthesia, medication used, intraoperative data and complications were collected. RESULTS: During the study period, spinal anesthesia was the most popular technique used in fetoscopic surgery (71%). Other anesthetic techniques used were general anesthesia with endotracheal tube (GA) (20.5%), epidural anesthesia (1.3%), combined spinal and epidural anesthesia (0.7%), failed spinal anesthesia converting to GA (2.6%) and local anesthesia with sedation (3.9%). Most frequent anesthetic-related complication was maternal hypotension which occurs in 115 out of 152 patients (75.6%). All of 5 cases (3.3%) of postoperative pulmonary edema received SA. Fetal death after operation was 25 in 152 records (16.4%). None of patients received GA experienced desaturation, pulmonary aspiration, failed intubation or pulmonary edema. CONCLUSION: Spinal anesthesia (SA) is the most frequent technique used for fetoscopy, and hypotension is the most common complication. Since pulmonary edema was also found, judicious perioperative fluid management should be implemented to prevent postoperative pulmonary edema.

Popliteal sciatic nerve block for high-risk patients undergoing lower limb angioplasty: A prospective double-blinded randomized controlled trial.

BACKGROUND: To assess the rate of conversion to general anesthesia, sedative and analgesic drug-sparing effects, and complications of popliteal sciatic nerve block (PSNB) compared with a sham block during lower limb angioplasty. METHODS: A randomized, controlled, double-blinded trial of patients with chronic limb-threatening ischemia (CLTI) who receive PSNB with 0.25% levobupivacaine 20 mL compared with a sham block (control) during lower limb angioplasty. Pain scores, conversion rate to general anesthesia, amount of sedoanalgesia drug usage, complications, and satisfaction with the anesthesia technique by surgeons and patients were assessed. RESULTS: Forty patients were enrolled in this study. Two of 20 (10%) control group patients were converted to general anesthesia, while none of the patients in the intervention group required general anesthesia (P = .487). Pain scores before PSNB did not differ between the groups (P = .771). After the block, pain scores in the block group were lower than those in the control group: 0 (0, 1.5) (median, interquartile range) and 2.5 (0.5, 3.5), respectively (P = .024). The analgesic effect persisted until immediately after the surgery (P = .035). There was no difference in pain scores at the 24-hours follow-up visit (P = .270). The total propofol and fentanyl dosage requirements, a number of patients who required propofol and fentanyl, side effects, and satisfaction were not different between the groups. No major complications were noted. CONCLUSIONS: PSNB provided effective pain relief during and immediately after lower limb angioplasty, but did not statistically affect the rate of conversion to general anesthesia, sedoanalgesia drug usage, or complications.

Crisis Team Management in a Scarce Resource Setting: Angkor Hospital for Children in Siem Reap, Cambodia.

INTRODUCTION: A crisis team management (CTM) simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2), crisis team training (3), and TeamSTEPPs© models (4). The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance. METHODS: Each of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5). CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course. RESULTS: Of the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve (p < 0.05) for team structure, leadership, situation monitoring, and communication. Team performance areas that improved the most were: discussion of team performance, communication, and exchange of information. CONCLUSION: Teaching of non-technical skills can be effective in a setting with scarce resources in a Southeastern Asian country.