simulation in anaesthesia at the royal adelaide hospital dr graham lowry fanzca
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Simulation in Anaesthesiaat the Royal Adelaide Hospital
Dr Graham Lowry FANZCA
The Royal Adelaide Hospital Adult Tertiary Teaching Hospital
∞ Affiliated with the University of Adelaide
∞ 680 beds
∞ 23 operating theatres
∞ 24 ICU / 10 HDU/ICU beds
Major trauma referral centre for Sth Australia
∞ Receives 800 retrievals/year
Department of Anaesthesia
Branch of Critical CareAnaesthesia/Pain/Hyperbaric medicine52 FTE Consultants32 Registrars
Simulation Unit Operational since 2003
Teaching/education role
∞ Interns
∞ Registrars/trainees
∞ Consultant anaesthetists
∞ Technical and non-technical skills
Relatively low budget
Specialty of Anaesthesia Five years of postgraduate training
∞ Major focus of training on developing technical skills
Conflict of decreased working hours versus need for clinical experience
∞ Aging population
∞ More complex surgery
Increased emphasis from ANZCA for training in non-technical skills.
Why Consultant Anaesthetists?Historically, a lack of training in this areaOften seen as leaders during a crisis in theatre BUT:∞No leadership training∞Often poor followers
Crisis Resource Management training is not mandatory
The Scenarios Clearly defined goals important
Simple clinical scenarios
∞ Diagnostic uncertainty useful for teaching human factors
∞ Team dynamics create complexity
∞ Level of fidelity always a challenge
Self reflection and evaluation important learning component
Challenges……1 Changing the culture
Stressful for
∞ for participants
∞ facilitators
Labour intensive
∞ maintaining service commitment versus patient safety and quality of care.
Challenges……2
Availability of relevant, validated outcome measures.
Adequate funding and resource allocationManaging participants’ expectations and comfort
levels
Advantages ……1
Allows training/experience in rare (but catastrophic) events
Breaks down the “silos”Work as a team, train as a team even if the “team”
is constantly changing
Advantages ……2
Training/practicing in contextIssues of access to facilitiesMoving beyond the operating theatre…